Postoperative Intensive Care Unit Requirements After Elective Craniotomy

Abstract

Objective Commonly, patients undergoing craniotomy are admitted to an intensive care setting post-operatively to allow for close monitoring. We aim to determine the frequency with which patients who have undergone elective craniotomies require intensive care unit level interventions or experience significant complications during the post-operative period to identify a subset of patients for whom an alternative to ICU level care may be appropriate. Methods Following Institutional Review Board approval, a prospective, consecutive cohort of adult patients undergoing elective craniotomy was established at the Massachusetts General Hospital between the dates of April 2010 and March 2011. Inclusion criteria were intradural operations requiring craniotomy performed on adults (18 years of age or greater). Exclusion criteria were cases of an urgent or emergent nature, patients who remained intubated post-operatively, and patients who had a ventriculostomy drain in place at the conclusion of the case. Results 400 patients were analyzed. Univariate analysis revealed that diabetics (p = 0.00047), patients who required intra-operative blood product administration (p = 0.032), older patients (p < 0.0001), patients with higher intra-operative blood losses (p = 0.041), and patients who underwent longer surgical procedures (p = 0.021) were more likely to require ICU-level interventions or experience significant post-operative complications. Multivariate analysis only found diabetes (p = 0.0005) and age (p = 0.0091) to be predictive of a patient’s need for post-operative intensive care unit admission. Conclusions Diabetes and older age predict the need for ICU-level intervention after elective craniotomy. Properly selected patients may not require post-craniotomy ICU monitoring. Further study of resource utilization is necessary to validate these preliminary findings, particularly in different hospital types.

29 Postoperative Care and Complications Management

“…However, in selected patients, ICU admission may not be necessary. 5 The required level and duration of monitoring after skull base surgery is determined by the following: 1. Preoperative clinical status and comorbidities 2.…”

Postoperative care of the neurosurgical patient

“…A multivariate analysis in a recent retrospective study of 400 elective patients undergoing intradural operations revealed only diabetes and older age to be predictive for postoperative ICU admission [2]. In an accompanying editorial, Hecht et al [3] stated that serious problems after craniotomy mostly occur within the first postoperative hours.…”

“…This approach seems feasible, although a lack of correlation in such a small cohort does not mean that these factors alone indicate the need for intensive care [4]. Other relevant factors are intraoperative bleeding, blood product administration, and duration of surgery [2]. To test coagulation sufficiency and the risk of postoperative bleeding, fibrinogen appears to be a modifiable risk factor, as levels below 2 g/l correlate with a 10-fold increase in risk of postoperative hematoma [5].…”

Interferência e características do edema periorbital no exame pupilar após craniotomia

“…The most feared complications after craniotomy are intracranial hematoma formation on the surgical site and cerebral edema as a result of surgical trauma, leading to an increase in intracranial pressure. (5)(6)(7)(8)(9)(10) The performance of a bedside neurological examination is one of the possible evaluations for early detection of intracranial hypertension.…”