John Q. H. Bui, M.B.B.S., Rajith L. Mendis, M.B.B.S., James M. van Gelder, F.R.A.C.S., Mark M. P. Sheridan, F.R.A.C.S., Kylie M. Wright, M.Clin.Prac.(Neurosci), and Matthias Jaeger, M.D
Journal of Neurosurgery 115:6:1236-1241, 2011.
OBJECT
Routine postoperative admission to the intensive care unit (ICU) is often considered a necessity in the treatment of patients following elective craniotomy but may strain already limited resources and is of unproven benefit. In this study the authors investigated whether routine postoperative admission to a regular stepdown ward is a safe alternative.
METHODS
Three hundred ninety-four consecutive patients who had undergone elective craniotomy over 54 months at a single institution were retrospectively analyzed. Indications for craniotomy included tumor (257 patients) and transsphenoidal (63 patients), vascular (31 patients), ventriculostomy (22 patients), developmental (13 patients), and base of skull conditions (8 patients). Recorded data included age, operation, reason for ICU admission, medical emergency team (MET) calls, in-hospital mortality, and postoperative duration of stay.
RESULTS
Three hundred forty-three patients were admitted to the regular ward after elective craniotomy, whereas there were 43 planned and 8 unplanned ICU admissions. The most common reasons for planned ICU admissions were anticipated lengthy operations (42%) and anesthetic risks (40%); causes for unplanned ICU admissions were mainly unexpected slow neurological recovery and extensive intraoperative blood loss. Of the 343 regular ward admissions, 10 (3%) required a MET call; only 3 of these MET calls occurred within the first 48 postoperative hours and did not lead to an ICU admission. The overall mortality rate in the investigated cohort was 1%, with no fatalities in patients admitted to the normal ward postoperatively.
CONCLUSIONS
Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients
Address correspondence to: Matthias Jaeger, M.D., Department of Neurosurgery, Liverpool Hospital, Locked Bag 7103, Liverpool BC, New South Wales 1871, Australia. email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
Where do you observe your patients after elective craniotomy?