The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study

Abstract

The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study L'influence des soins intensifs postopératoires sur le devenir des patients en bonne santé ayant subi une neurochirurgie non urgente: une étude unicentrique par appariement des scores de propension Abstract Purpose In the last three years, all elective neurosurgical cases were performed by a single surgeon at Nara Medical University. For the last year and a half, all patients were transferred to a newly created neurosurgical intensive care unit. The purpose of this study was to evaluate the impact of admission to an intensive care unit after elective neurosurgery. Methods This study was conducted as a retrospective clinical chart review. Institutional ethics approval was waived, and we reviewed the charts of 296 neurosurgical patients who were American Society of Anesthesiologists' physical status I-II. To avoid channelling bias, propensity score analysis was used to generate a set of matched cases (patients transferred to the intensive care unit [ICU]) and controls (patients transferred to the neurosurgical ward). This process resulted in 104 matched pairs of elective surgical patients who did or did not have an ICU admission after surgery. Glasgow outcome scale (GOS) at discharge or at three months after the operation was compared as the primary outcome measure. As secondary outcome measures, we also compared rates of severe early complications and patient satisfaction regarding perioperative patient care.Results With an unmatched population, poor GOS tended to occur more often in the non-ICU group than in the ICU group (6.5% vs 2.3%, respectively). Mortality rates and severe early complication rates also tended to be higher in the non-ICU group than in the ICU group (2.4% and 5.3%, respectively, non-ICU group vs 0.8% and 2.3%, respectively, ICU group). However, after propensity score matching, there was no difference regarding the GOS between groups. Both groups showed very high good outcome percentages (98.1% ICU vs 97.1% non-ICU). With regard to mortality rates and severe early complications, both groups showed low mortality (0.96% vs 0.96%) and complication rates (2.89% ICU vs 3.85% non-ICU). Patient care in the ICU failed to increase patient satisfaction regarding the overall hospital care. Conclusion The results of this analysis suggest that admission to an ICU after elective neurosurgery has little impact on outcomes. RésuméObjectif Au cours des trois dernie`res anne´es, toutes les neurochirurgies non urgentes ont e´te´effectue´es par un seul chirurgien a`la Nara Medical University et, au cours des 18 derniers mois, tous les patients ont e´te´transfe´re´s dans une nouvelle unite´de soins intensifs en neurochirurgie. L'objectif

Perioperative, Single-Surgeon Experience in Cerebrovascular Bypass Procedures at Academic Medical Center and Community Hospital

“…When the expected mortality rate following elective surgeries is low, the value of subspecialized neurointensive care is less clear. 2 In our series, there was only one (3.6%) death.…”

“…While dedicated neurocritical care improves outcomes for acute intracranial hemorrhage and head trauma, evidence exists to the contrary for elective neurosurgical cases on patients with few comorbidities. 1,2,3 Moyamoya disease, or cerebral arterial steno-occlusive disease, is an occlusive cerebrovascular disease affecting the internal carotid artery. In patients receiving medical management of single hemispheric moyamoya disease diagnosed clinically, the 5-year risk of recurrent ipsilateral stroke is to be 65%.…”

Comparison of Perioperative Characteristics and Clinical Outcomes of COVID-19 and non-COVID-19 Patients Undergoing Neurosurgery—A Retrospective Analysis

“…However, after propensity score matching, no difference in GOS was seen between the groups. 11 In another retrospective study, longer duration of MV and ICU stay was observed among survivors as compared with nonsurvivors of severe COVID-19 illness. 12 The duration of MV and ICU stay was more in COVID-19 patients in our study, probably due to the lower GCS score and pulmonary involvement at hospital admission.…”

Assessment of selected quality fields of nursing care in neurosurgical wards: a prospective study of 530 people – multicenter studies

“…Thorne et al27 reported 70%–80% of positive opinions concerning neurosurgical care, but indicated some administrative flaws. Terada et al28 argued that intensive postoperative care on neurosurgical wards had no impact on the overall satisfaction of patients with hospital care. Wasilewski,22 who conducted his study on a neurosurgical ward, proved that psychosocial care related to social support is crucial.…”