Postoperative Admission of Adult Craniotomy Patients to the Neuroscience Ward Reduces Length of Stay and Cost

Sun, Matthew Z.; Babayan, Diana; Chen, Jia-Shu; Wang, Maxwell M; Naik, Priyanka; Reitz, Kara; Li, Jingyi Jessica; Pouratian, Nader; Kim, Won

doi:10.1093/neuros/nyab089

Cited by 6 publications

(9 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies were conducted in the United States (n = 10), Canada (n = 9), the United Kingdom (n = 2) (17,18), the Netherlands (n = 2) (19,20), Italy (n = 2) (21,22), Japan (n = 1) (23), and Australia (n = 1) (24). Five included studies were published earlier this year (2021) (20,21,(25)(26)(27). Publications by Bernstein and Mannien's groups from the University of Toronto (28)(29)(30)(31)(32)(33)(34)(35)(36) and Ter Laan et al (19,20) contained significant overlap of included patients, so only the most comprehensive study from each center was included in figures and summative analyses.…”

Section: Resultsmentioning

confidence: 99%

Reexamining the Role of Postoperative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review*

Azad

Shah

Kannapadi

et al. 2022

Critical Care Medicine

View full text Add to dashboard Cite

The standard-of-care for postoperative care following elective craniotomy has historically been ICU admission. However, recent literature interrogating complications and interventions during this postoperative ICU stay suggests that all patients may not require this level of care. Thus, hospitals began implementing non-ICU postoperative care pathways for elective craniotomy. This systematic review aims to summarize and evaluate the existing literature regarding outcomes and costs for patients receiving non-ICU care after elective craniotomy. DATA SOURCES:A systematic review of the PubMed database was performed following PRISMA guidelines from database inception to August 2021. STUDY SELECTION:Included studies were published in peer-reviewed journals, in English, and described outcomes for patients undergoing elective craniotomies without postoperative ICU care.DATA EXTRACTION: Data regarding study design, patient characteristics, and postoperative care pathways were extracted independently by two authors. Quality and risk of bias were evaluated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence tool and Risk Of Bias In Non-Randomized Studies-of Interventions tool, respectively. DATA SYNTHESIS:In total, 1,131 unique articles were identified through the database search, with 27 meeting inclusion criteria. Included articles were published from 2001 to 2021 and included non-ICU inpatient care and same-day discharge pathways. Overall, the studies demonstrated that postoperative non-ICU care for elective craniotomies led to length of stay reduction ranging from 6 hours to 4 days and notable cost reductions. Across 13 studies, 53 of the 2,469 patients (2.1%) intended for postoperative management in a non-ICU setting required subsequent care escalation. CONCLUSIONS: Overall, these studies suggest that non-ICU care pathways for appropriately selected postcraniotomy patients may represent a meaningful opportunity to improve care value. However, included studies varied greatly in patient selection, postoperative care protocol, and outcomes reporting. Standardization and multi-institutional collaboration are needed to draw definitive conclusions regarding non-ICU postoperative care for elective craniotomy.

show abstract

Section: Resultsmentioning

confidence: 99%

Reexamining the Role of Postoperative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review*

Azad

Shah

Kannapadi

et al. 2022

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…7,12 Finally, 2 studies excluded patients with a ventriculostomy drain in place at the conclusion of the surgery. 9,11 Our criteria are similar to those in the studies by Florman and et al and Young and et al and may include a broader set of indications for select patients, including supratentorial and infratentorial tumors, MVD, Chiari I decompressions, cavernoma resections, ventriculoperitoneal shunt placements, craniotomies for deep brain stimulation electrode implantations, and EC-IC bypasses. However, our protocol is more conservative for age; although other published protocols include all adult patients, 7-12 our criteria limit the NICE protocol to patients younger than age 65 years.…”

Section: Discussionmentioning

confidence: 99%

“…9,11 Our criteria are similar to those in the studies by Florman and et al and Young and et al and may include a broader set of indications for select patients, including supratentorial and infratentorial tumors, MVD, Chiari I decompressions, cavernoma resections, ventriculoperitoneal shunt placements, craniotomies for deep brain stimulation electrode implantations, and EC-IC bypasses. However, our protocol is more conservative for age; although other published protocols include all adult patients, 7-12 our criteria limit the NICE protocol to patients younger than age 65 years. Moreover, similar to Young and colleagues, 12 our protocol excludes patients with an estimated blood loss exceeding 500 mL, but is less conservative in that our protocol excludes patients with an operative time exceeding 8 hours instead of 5.…”

Section: Discussionmentioning

confidence: 99%

“…7,12 Finally, 2 studies excluded patients with a ventriculostomy drain in place at the conclusion of the surgery. 9,11 Our criteria are similar to those in the studies by Florman and et al and Young and et al and may 12 our protocol excludes patients with an estimated blood loss exceeding 500 mL, but is less conservative in that our protocol excludes patients with an operative time exceeding 8 hours instead of 5.…”

Section: Patient Selectionmentioning

confidence: 97%

“…A review of the literature demonstrates that elective, supratentorial tumor resections were the most common indication enrolled in such a protocol with 3 of the 6 protocols exclusively enrolling these patients. [7][8][9] Chiari I decompressions and MVD were also common procedures included in 3 other protocols. [10][11][12] Some studies, however, included a broader set of indications.…”

Section: Patient Selectionmentioning

confidence: 99%

See 2 more Smart Citations

A Protocol for Reducing Intensive Care Utilization After Craniotomy: A 3-Year Assessment

et al. 2023

View full text Add to dashboard Cite

BACKGROUND:Craniotomy patients have traditionally received intensive care unit (ICU) care postoperatively. Our institution developed the “Non-Intensive CarE” (NICE) protocol to identify craniotomy patients who did not require postoperative ICU care.OBJECTIVE:To determine the longitudinal impact of the NICE protocol on postoperative length of stay (LOS), ICU utilization, readmissions, and complications.METHODS:In this retrospective cohort study, our institution's electronic medical record was queried to identify craniotomies before protocol deployment (May 2014-May 2018) and after deployment (May 2018-December 2021). The primary end points were average postoperative LOS and ICU utilization; secondary end points included readmissions, reoperation, and postoperative complications rate. End points were compared between pre- and postintervention cohorts.RESULTS:Four thousand eight hundred thirty-seven craniotomies were performed from May 2014 to December 2021 (2302 preprotocol and 2535 postprotocol). Twenty-one percent of postprotocol craniotomies were enrolled in the NICE protocol. After protocol deployment, the overall postoperative LOS decreased from 4.0 to 3.5 days (P = .0031), which was driven by deceased postoperative LOS among protocol patients (average 2.4 days). ICU utilization decreased from 57% of patients to 42% (P < .0001), generating ∼$760 000 in savings. Return to the ICU and complications decreased after protocol deployment. 5.8% of protocol patients had a readmission within 30 days; none could have been prevented through ICU stay.CONCLUSION:The NICE protocol is an effective, sustainable method to increase ICU bed availability and decrease costs without changing outcomes. To our knowledge, this study features the largest series of patients enrolling in an ICU utilization reduction protocol. Careful patient selection is a requirement for the success of this approach.

show abstract

Routine ICU admission after brain tumor surgery: retrospective validation and critical appraisal of two prediction scores

et al. 2023

View full text Add to dashboard Cite

Background Routine admission to an intensive care unit (ICU) following brain tumor surgery has been a common practice for many years. Although this practice has been challenged by many authors, it has still not changed widely, mainly due to the lack of reliable data for preoperative risk assessment. Motivated by this dilemma, risk prediction scores for postoperative complications following brain tumor surgery have been developed recently. In order to improve the ICU admission policy at our institution, we assessed the applicability, performance, and safety of the two most appropriate risk prediction scores. Methods One thousand consecutive adult patients undergoing elective brain tumor resection within 19 months were included. Patients with craniotomy for other causes, i.e., cerebral aneurysms and microvascular decompression, were excluded. The decision for postoperative ICU-surveillance was made by joint judgment of the operating surgeon and the anesthesiologist. All data and features relevant to the scores were extracted from clinical records and subsequent ICU or neurosurgical floor documentation was inspected for any postoperative adverse events requiring ICU admission. The CranioScore derived by Cinotti et al. (Anesthesiology 129(6):1111–20, 5) and the risk assessment score of Munari et al. (Acta Neurochir (Wien) 164(3):635–641, 15) were calculated and prognostic performance was evaluated by ROC analysis. Results In our cohort, both scores showed only a weak prognostic performance: the CranioScore reached a ROC-AUC of 0.65, while Munari et al.’s score achieved a ROC-AUC of 0.67. When applying the recommended decision thresholds for ICU admission, 64% resp. 68% of patients would be classified as in need of ICU surveillance, and the negative predictive value (NPV) would be 91% for both scores. Lowering the thresholds in order to increase patient safety, i.e., 95% NPV, would lead to ICU admission rates of over 85%. Conclusion Performance of both scores was limited in our cohort. In practice, neither would achieve a significant reduction in ICU admission rates, whereas the number of patients suffering complications at the neurosurgical ward would increase. In future, better risk assessment measures are needed.

show abstract

Postoperative Admission of Adult Craniotomy Patients to the Neuroscience Ward Reduces Length of Stay and Cost

Cited by 6 publications

References 12 publications

Reexamining the Role of Postoperative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review*

Reexamining the Role of Postoperative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review*

A Protocol for Reducing Intensive Care Utilization After Craniotomy: A 3-Year Assessment

Routine ICU admission after brain tumor surgery: retrospective validation and critical appraisal of two prediction scores

Contact Info

Product

Resources

About