Are Routine Intensive Care Admissions Needed after Endovascular Treatment of Unruptured Aneurysms?

Burrows, Anthony M.; Rabinstein, Alejandro A.; Cloft, Harry J.; Kallmes, David F.; Lanzino, Giuseppe

doi:10.3174/ajnr.a3566

Cited by 14 publications

(13 citation statements)

References 7 publications

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“…Two smaller cohort analyses support our findings and suggest that it is an unnecessary practice 11 12. A prospective study of 200 patients by Burrows et al showed that a risk stratification strategy could be used safely and successfully to determine which patients require post-procedural ICU admission 12.…”

Section: Discussionsupporting

confidence: 76%

“…In previous reports the vast majority of peri-procedural complications from elective endovascular aneurysm therapy occurred either during the procedure or within the first 4 hours following the procedure 10 12 16. Post-anesthesia recovery units provide low patient-to-nurse ratios (often 1:1 or 1:2) and invasive monitoring capabilities, allowing for rapid identification and management of potential complications.…”

Section: Discussionmentioning

confidence: 99%

“…In the neurosurgical literature, retrospective case series have demonstrated success with selective use of the ICU, but reports conflict when neurovascular patient populations are analyzed, and there are no guidelines on whether unruptured intracranial aneurysms treated with coil embolization should be placed in the ICU following treatment 8–11. One study showed that postoperative placement to a regular floor unit may be safe in selected patients 12. Another study evaluated the safety and cost-effectiveness of an immediate care step-down unit for patients after uncomplicated neurointerventional procedures 11…”

Section: Introductionmentioning

confidence: 99%

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Is intensive care monitoring necessary after coil embolization of unruptured intracranial aneurysms?

Stetler

Griauzde

Saadeh

et al. 2016

J NeuroIntervent Surg

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IntroductionPatients with an unruptured intracranial aneurysm treated with coil embolization are routinely admitted to the intensive care unit (ICU) after the procedure; however, this practice is questionable. The purpose of this study was to determine if routine admission to the ICU is necessary for patients undergoing coil embolization of an unruptured intracranial aneurysm.MethodsWe conducted a retrospective cohort study of all patients undergoing elective endovascular treatment of an unruptured intracranial aneurysm between 2005 and 2012 at our institution. Multivariate regression analysis was performed to identify predictors of outcome. Cost savings analysis compared ICU admission to step-down or telemetry unit admission.Results311 unruptured intracranial aneurysms were treated by coil embolization (190), balloon remodeling (13), or stent-assisted coiling (108). Eleven (3.5%) neurologic complications were noted; 5 (1.6%) of these were permanent. Multivariate regression analysis identified female sex (p=0.028), hypercoagulability (p=0.021), aneurysm size >2 cm (p=0.003), and intraoperative rupture (p<0.001) as predictors of a post-procedural neurologic complication. Cost savings were 57% for admission to a step-down unit and 32% for admission to a telemetry unit compared with ICU admission.ConclusionsNeurologic complications are rare in the treatment of unruptured intracranial aneurysms, suggesting that routine ICU admission after treatment may not be necessary. Female sex, history of hypercoagulability, aneurysm size >2 cm, and an intraprocedural rupture were predictive of a postoperative complication. ICU monitoring in these subgroups may therefore be warranted.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is intensive care monitoring necessary after coil embolization of unruptured intracranial aneurysms?

Stetler

Griauzde

Saadeh

et al. 2016

J NeuroIntervent Surg

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“…Admission to a unit where a close follow-up can be carried on by a properly trained medical and nursing staff is crucial. Unlike uneventful unruptured aneurysm embolization, 19 complications after DAVF endovascular treatment may appear several hours postprocedure. For that reason and for assuring better surveillance of cerebral function, we believe that these patients should stay overnight in high dependency units, such as the PACU in our hospital.…”

Section: Discussionmentioning

confidence: 99%

Intraventricular hemorrhage after dural fistula embolization

Carvalho¹,

Machin²,

Manzanera³

et al. 2017

Brazilian Journal of Anesthesiology (English Edition)

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“…For 343 regular ward admission patients after elective craniotomy, the mortality rate was 0% and adverse events required a medical emergency call was 3%, but none needed an ICU admission [7]. Moreover, for patients after elective embolization of unruptured intracranial aneurysms, they could be safely observed in a regular ward rather than being admitted to the ICU should they had no major co-morbidities, intraoperative complications or complex aneurysm morphology [13]. Meanwhile, patients following carotid endarterectomy could be safely transferred to a surgical floor if they remained neurologically and hemodynamically stable for 3 h postoperatively [14].…”

Section: International Journal Of Neurosciencementioning

confidence: 99%

Delayed admission to ICU does not increase the mortality of patients post neurosurgery

Zhou

Pan

Huang

et al. 2014

International Journal of Neuroscience

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Increasing shortage of intensive care resources is a worldwide problem. While routine postoperative admission to the intensive care unit (ICU) of patients undergoing neurosurgery is a long established practice for many hospitals. Therefore, some neurosurgical patients have to be cared in post anesthesia care unit (PACU) before ICU admission during high ICU occupancy. The aim of this study was to compare the outcome of neurosurgical patients immediately admitted to the ICU post operation with those who were required to wait for ICU bed in PACU and managed by anesthesiologists before ICU admission. All adult neurosurgical patients admitted to our ICU between January 2010 and July 2013 were retrospectively analyzed. Recorded data included demographic data, surgical categories, end time of operation, operation hours, postoperative complication, hospital/ICU length of stay and cost, Glasgow coma score (GCS) on ICU discharge and ICU mortality. A total of 989 neurosurgical patients were evaluated. Nine hundred thirty-seven (94.7%) patients were immediately admitted and 52 (5.3%) patients had delayed ICU admission. Median PACU waiting hours was 4.3 h (interquartile range: 2.0-10.2 h). Delayed ICU admission post neurosurgery was highly associated with the end time of operation (p = 0.019) and high ICU occupancy (p < 0.0001). Average GCS on ICU discharge was higher in immediately admitted group (13.0 ± 3.5 vs. 11.4 ± 4.5, p = 0.012). However, delayed admission to ICU post neurosurgery was not associated with prolonged ICU length of stay, increased ICU mortality, increased postoperative complication and hospital/ICU cost (all p > 0.05). Thus, an algorithm for appropriate disposition of neurosurgical patients is warranted so as to balance the quality of care and control of scarce intensive resources.

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Are Routine Intensive Care Admissions Needed after Endovascular Treatment of Unruptured Aneurysms?

Cited by 14 publications

References 7 publications

Is intensive care monitoring necessary after coil embolization of unruptured intracranial aneurysms?

Is intensive care monitoring necessary after coil embolization of unruptured intracranial aneurysms?

Intraventricular hemorrhage after dural fistula embolization

Delayed admission to ICU does not increase the mortality of patients post neurosurgery

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