A Novel Protocol for Reducing Intensive Care Utilization After Craniotomy. Issue 3 (5th June 2021)

• Record Type: Journal Article
• Authors: Pendharkar, Arjun V; Shahin, Maryam N; Awsare, Sohun S; Ho, Allen L; Wachira, Christine; Clevinger, Johnathan; Sigurdsson, Sveinn; Lee, Yohan; Wilson, Alicia; Lu, Amy C; Gephart, Melanie Hayden
• Is Part Of: Neurosurgery. Volume 89:Issue 3(2021)
• Page Start: 471
• Page End: 477
• Publication Date: 2021-06-05
• Subjects: Intensive care unit -- Cost -- Craniotomy -- Outcome -- Quality; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyab187
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: There is a growing body of evidence suggesting not all craniotomy patients require postoperative intensive care. OBJECTIVE: To devise and implement a standardized protocol for craniotomy patients eligible to transition directly from the operating room to the ward—the Non-Intensive CarE (NICE) protocol. METHODS: We preoperatively identified patients undergoing elective craniotomy for simple neurosurgical procedures with age <65 yr and American Society of Anesthesiologists (ASA) class of 1, 2 or 3. Postoperative eligibility was confirmed by the surgical and anesthesia teams. Upon arrival to the ward, patients were staffed with a neuroscience nurse for hourly neurological examinations for the first 8 h. Patient demographics, clinical characteristics, and outcomes were prospectively collected to evaluate the NICE protocol. RESULTS: From February 2018 to 2019, 63 patients were included in the NICE protocol with a median age of 46 yr and 65% female predominance. Of the operations performed, 38.1% were microvascular decompressions, 31.7% were craniotomy for tumor, 15.9% were cavernous malformation resections, and 14.3% were Chiari decompressions. No patients required transfer to the intensive care unit (ICU). Median length of stay was 2 d. There was an 11.1% overall readmission rate within the median follow-up period of 48 d. Three patients (4.8%) required reoperation at time of readmission within the follow-up period (1 postoperative subdural hematoma, 2 cerebrospinal fluid leak repair). None of these complications could have been identified with a postoperative ICU stay. CONCLUSION: In our pilot trial of the NICE protocol, no patients required postoperative transfer to the ICU.