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

Abstract

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.

Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

“…The characteristics of included studies [ 1 , 2 , 6 , 9 – 14 , 17 , 23 – 46 ], which were published between 2002 and 2021 and enrolled 356,936 patients in total and 40,348 patients with delayed ICU admission (11.3%), are presented in Table 1 . One study had multinational design [ 10 ], and nine studies had multicenter design [ 1 , 12 , 25 , 27 , 28 , 32 , 37 , 40 , 43 ], while the other studies had single-center design.…”

Caring for critically ill patients outside intensive care units due to full units: a cohort study

“…Since most critical illnesses are time sensitive, delaying ICU admission can lead to a worse prognosis if patients do not have access to adequate care, but there are conflicting data in the literature regarding this issue. Some authors describe a 1.5% increase in the risk of death for each hour of delay in ICU admission 3 for patients treated in hospital wards, while others have described no change in prognosis for surgical patients cared for in the post-anesthesia care unit 28 .…”

Criteria for Intensive Care admission and monitoring after elective craniotomy

“…The criteria for post-operative admission to ICU, high-dependency unit or a specialized neurosurgical ward vary from institution to institution depending on local structures and characteristics of the available resources [27,28]. We propose a summary of criteria for ICU admission (Table II).…”

“…In other centers, patients are only admitted to the ICU if intra-cranial complications (i.e. early seizures, bleeding, brain oedema) develop during or immediately after surgery [5].…”