Selective Intensive Care Unit Admission After Adult Supratentorial Tumor Craniotomy: Complications, Length of Stay, and Costs

Laan, Mark ter; Roelofs, Suzanne; Huet, Ineke Van; Adang, Eddy; Bartels, Ronald H. M. A.

doi:10.1093/neuros/nyz388

Cited by 32 publications

(36 citation statements)

References 17 publications

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“…Although our brain tumor center treats mostly non-emergent patients (94%) with a high proportion of patients with prior surgery (25%), our pathology mix is similar to that of other centers and trends with national brain tumor demographics [25]. Additionally, while our findings are specific to patients with primary and secondary brain tumors, many of these measures are relevant and applicable to other specialties and are already being implemented in some centers [44,47,48,53,54].…”

Section: Future Enhancements and Generalizability Of This Paradigmmentioning

confidence: 68%

Streamlining brain tumor surgery care during the COVID-19 pandemic: A case-control study

et al. 2021

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Background The COVID-19 pandemic forced a reconsideration of surgical patient management in the setting of scarce resources and risk of viral transmission. Herein we assess the impact of implementing a protocol of more rigorous patient education, recovery room assessment for non-ICU admission, earlier mobilization and post-discharge communication for patients undergoing brain tumor surgery. Methods A case-control retrospective review was undertaken at a community hospital with a dedicated neurosurgery and otolaryngology team using minimally invasive surgical techniques, total intravenous anesthesia (TIVA) and early post-operative imaging protocols. All patients undergoing craniotomy or endoscopic endonasal removal of a brain, skull base or pituitary tumor were included during two non-overlapping periods: March 2019–January 2020 (pre-pandemic epoch) versus March 2020–January 2021 (pandemic epoch with streamlined care protocol implemented). Data collection included demographics, preoperative American Society of Anesthesiologists (ASA) status, tumor pathology, and tumor resection and remission rates. Primary outcomes were ICU utilization and hospital length of stay (LOS). Secondary outcomes were complications, readmissions and reoperations. Findings Of 295 patients, 163 patients were treated pre-pandemic (58% women, mean age 53.2±16 years) and 132 were treated during the pandemic (52% women, mean age 52.3±17 years). From pre-pandemic to pandemic, ICU utilization decreased from 92(54%) to 43(29%) of operations (p<0.001) and hospital LOS≤1 day increased from 21(12.2%) to 60(41.4%), p<0.001, respectively. For craniotomy cohort, median LOS was 2 days for both epochs; median ICU LOS decreased from 1 to 0 days (p<0.001), ICU use decreased from 73(80%) to 29(33%),(p<0.001). For endonasal cohort, median LOS decreased from 2 to 1 days; median ICU LOS was 0 days for both epochs; (p<0.001). There were no differences pre-pandemic versus pandemic in ASA scores, resection/remission rates, readmissions or reoperations. Conclusion This experience suggests the COVID-19 pandemic provided an opportunity for implementing a brain tumor care protocol to facilitate safely decreasing ICU utilization and accelerating discharge home without an increase in complications, readmission or reoperations. More rigorous patient education, recovery room assessment for non-ICU admission, earlier mobilization and post-discharge communication, layered upon a foundation of minimally invasive surgery, TIVA anesthesia and early post-operative imaging are possible contributors to these favorable trends.

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Section: Future Enhancements and Generalizability Of This Paradigmmentioning

confidence: 68%

Streamlining brain tumor surgery care during the COVID-19 pandemic: A case-control study

et al. 2021

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“…Purely calvarian bone tumors, pituitary tumors, and endoscopic procedures were excluded for analysis. Details of our post-operative regimen were reported previously [ 7 ]. In cohort A patients were routinely admitted to ICU or MCU post-operatively; in cohort B a “no-ICU-unless” policy was applied.…”

Section: Methodsmentioning

confidence: 99%

“…Previously, the need for post-operative admittance to medium or intensive care units after craniotomy was challenged [1][2][3][4][6][7][8]. The main reason for changing the post-operative regimen was the fact that patients on average reported quick recovery after tumor craniotomy, but complained about the burden of the stay at the ICU post-operatively.…”

Section: Introductionmentioning

confidence: 99%

“…Also, a change in regimen could possibly reduce the burden on ICU planning (which has led to postponing surgery) and increase cost efficiency. After introduction of a “no-ICU-unless” protocol for our craniotomy patients we previously reported short-term results and found satisfied patients, comparable complication rates, and significant reduction of costs [ 7 ]. In this new report we present the results 2 years after introduction of this protocol was implemented.…”

Section: Introductionmentioning

confidence: 99%

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Reducing the burden of brain tumor surgery

et al. 2020

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Background Even though the need has been challenged, admitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice. We have introduced a "no ICU, unless" policy for tumor craniotomy patients and evaluate costs, complications, and length of stay. Methods A prospective cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 2 years after introduction of the new policy with the year before. Results A reduction in ICU/MCU admittance from 88 to 23% of patients was found resulting in 13% cost reduction. Also, the new policy resulted in a 1.4-day shorter post-operative length of stay. Minor complications were reduced, while major complications remained the same. All major complications are reviewed. Conclusions We show that routine post-operative ICU/MCU admittance after tumor craniotomy does not reduce complications, but actually interferes with recovery of our patients. Changing the paradigm results in earlier discharge and cost reduction.

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“…Identifying postoperative patients requiring ICU admission is a challenging but necessary daily task. In the clinical setting, some patients undergoing cerebral surgery require unplanned ICU transfer despite thorough evaluation [22, 23] . Therefore, it is vital to improve the positive rate of identification, especially for those patients assessed as transferred to the ward, but transferred to the ICU after surgery.…”

Section: Introductionmentioning

confidence: 99%

Unplanned ICU transfer from post-anesthesia care unit following cerebral surgery: A retrospective study

Cao

Fan

et al. 2022

Preprint

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Background Unplanned transfer to intensive care unit (ICU) lead to reduced trust of patients and their families in medical staff and challenge medical staff to allocate scarce ICU resources. This study aimed to explore the incidence and risk factors of unplanned transfer to ICU during emergence from general anesthesia after cerebral surgery, and to provide guidelines for preventing unplanned transfer from post-anesthesia care unit (PACU) to ICU following cerebral surgery. Methods This was a retrospective case-control study and included patients with unplanned transfer from PACU to ICU following cerebral surgery between January 2016 and December 2020. The control group comprised patients matched (2:1) for age (±5 years), sex, and operation date (±48 hours) as those in the case group. Stata14.0 was used for statistical analysis, and p <0.05 indicated statistical significance. Results A total of 11,807 patients following cerebral surgery operations were cared in PACU during the study period. Of the 11,807 operations, 81 unscheduled ICU transfer occurred (0.686%). Finally, 76 patients were included in the case group, and 152 in the control group. The following factors were identified as independent risk factors for unplanned ICU admission after neurosurgery: low mean blood oxygen (OR=1.57, 95%CI: 1.20–2.04), low mean albumin (OR=1.14, 95%CI: 1.03–1.25), slow mean heart rate (OR=1.04, 95%CI: 1.00–1.08), blood transfusion (OR=2.78, 95%CI: 1.02–7.58), emergency surgery (OR=3.08, 95%CI: 1.07–8.87), lung disease (OR=2.64, 95%CI: 1.06–6.60), and high mean blood glucose (OR=1.71, 95%CI: 1.21–2.41). Conclusion We identified independent risk factors for unplanned transfer from PACU to ICU after cerebral surgery based on electronic medical records. Early identification of patients who may undergo unplanned ICU transfer after cerebral surgery is important to provide guidance for accurately implementing a patient's level of care.

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Selective Intensive Care Unit Admission After Adult Supratentorial Tumor Craniotomy: Complications, Length of Stay, and Costs

Cited by 32 publications

References 17 publications

Streamlining brain tumor surgery care during the COVID-19 pandemic: A case-control study

Streamlining brain tumor surgery care during the COVID-19 pandemic: A case-control study

Reducing the burden of brain tumor surgery

Unplanned ICU transfer from post-anesthesia care unit following cerebral surgery: A retrospective study

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