The Utility of Routine Intensive Care Admission for Patients Undergoing Intracranial Neurosurgical Procedures: A Systematic Review

Almeida, Cesar Cimonari de; Boone, M. Dustin; Laviv, Yosef; Kasper, Burkhard S.; Chen, Clark C.; Kasper, Ekkehard M.

doi:10.1007/s12028-017-0433-4

Cited by 41 publications

(26 citation statements)

References 45 publications

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“…2,7-9,11,12,17 Others have suggested comparable regimens could reduce costs. 2,8,12,13 Previous reported selection criteria for reduced postoperative monitoring were quite strict (eg age <65, small tumors, no comorbidity 13 ), whereas we chose to allow all supratentorial tumor cases to be admitted to the general neurosurgical ward, except when the surgeon or anesthesiologist judged otherwise based on expected duration of surgery, expected blood loss, comorbidities, and functional status. Even though selection might be more subjective this way, more patients can be included in the new regimen, which we have shown is safe; therefore, we do not see a need for more stringent criteria for ICU/MCU admission postcraniotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, this can result in significant savings. 2,8,12,13 In our hospital, 1-d admittance to ICU or MCU costs €2154 and €1421, respectively, whereas a day at the neurosurgical ward costs €395. This has to be balanced against potential increases in complication and length of stay.…”

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confidence: 94%

“…Traditionally, craniotomy patients are admitted to an (neurosurgical) intensive care unit (ICU) or other high- or medium-care (MCU) facilities for the first 12 to 24 h and transferred to the neurosurgical ward on the day after. 1,2 This regimen is recommended in order to be able to early detect severe postoperative complications (like hemorrhage, epilepsy, edema, etc), which are thought to occur mostly on the first postoperative day. 3-6 The need for postoperative intensive care admittance has been challenged, and even day-care tumor craniotomy has been advocated.…”

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confidence: 99%

“…3-6 The need for postoperative intensive care admittance has been challenged, and even day-care tumor craniotomy has been advocated. 1,2,7-12 Most postoperative complications do not need urgent intervention (like transient neurological deficits, infection, or CSF circulation problems), but immediate intervention is needed in case of postoperative hemorrhage or epileptic seizures.…”

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confidence: 99%

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

et al. 2019

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BACKGROUNDAdmitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice even though some studies have suggested lower level care is sufficient for selected patients. We have introduced a “no ICU, unless” policy for tumor craniotomy patients.OBJECTIVETo provide a quieter postoperative environment for patients, reduce the burden on the ICU department, and to evaluate whether costs can be reduced.METHODSA cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 1 yr after introduction (n = 109) of the new policy with the year before (n = 107). Rate of complications was evaluated, as was the length of stay and patient satisfaction using qualitative evaluation. Finally, costs were evaluated comparing the situation before and after implementation of the new protocol.RESULTSA reduction in ICU/MCU admittance from 64% to 24% of patients was found resulting in 13.3% cost reduction (€1950 per case), without increasing the length of stay at the ward. The length of stay in the hospital was similar. Complications were significantly reduced after implementing the new policy (0.98 vs 0.53 per patient, P = .003). Patients that were interviewed after the new policy reported feeling safe and at ease at the ward.CONCLUSIONChanging our policy from “ICU, unless” to “no ICU, unless” reduced complication rates and length of stay in the hospital while keeping patients satisfied. Hospital costs related to the admission have been significantly reduced by the new policy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 94%

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confidence: 99%

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confidence: 99%

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

et al. 2019

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“…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%

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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Neurosurgical Patient in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) in Postoperative Monitoring

Rodríguez

Geeraerts

2021

Neurosonology in Critical Care

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The basic principle of neurosurgical patient management is to ensure adequate brain tissue perfusion, maintaining a sufficient blood flow to supply energy and oxygen to the brain parenchyma. 2. If neuroworsening occurs after a neurosurgical procedure, prompt recognition is essential because it may be the first indication of potential complications. 3. In many clinical scenarios during neurosurgical postoperative period, TCD/ TCCS may have a transcendent role in diminished gap between neurological clinical examination and other investigations that may be invasive or require patient transport outside of the ICU. 4. Midline shift (MLS) monitoring is important for preventing neurological worsening and assess early neurosurgical intervention. Keep in mind that any amount of midline shift is considered abnormal. 5. Measurement of volume of Intracerebral Hematoma (ICH) is a very useful monitoring tool in the daily bedside following, and thus contribute to therapeutic decisions in real time interpreting the clinical trends. 6. The most used approach, to diagnose hydrocephalus by TCCS, is the measurement of the diameter of the third ventricle through the transtemporal window. 7. It is critical to interpret and integrate hemodynamic qualitative and quantitative trends (not only the absolute value) of the Spectral Doppler wave (blood flow velocity patterns) with the clinical context of the patient.

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The Utility of Routine Intensive Care Admission for Patients Undergoing Intracranial Neurosurgical Procedures: A Systematic Review

Abstract: Our systematic review demonstrates that routine postoperative ICU admission may not benefit carefully selected patients who have undergone elective intracranial neurosurgical procedures. In addition, limiting routine ICU admission may result in significant cost savings.

Cited by 41 publications

References 45 publications

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

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

Reducing the burden of brain tumor surgery

Neurosurgical Patient in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) in Postoperative Monitoring

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