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Brain & Heart ICU admission post-craniotomy for tumor

1. Introduction extensive resection of surgically accessible tumors has been
shown to improve survival and functional outcomes. 9-12
Primary brain tumors (PBTs) are neoplasms that arise Despite the potential benefits, elective craniotomies are not
from central nervous system cells. They can present without risks. 13-15 Their success and associated outcomes
1
with a wide range of clinical symptoms caused by local often depend on the individual patient’s condition and
invasion, compression of nearby anatomical structures, or circumstances.
elevated intracranial pressure. Among PBT, glioblastoma
2
represents the most common malignant neoplasm and the In addition, elective craniotomies have the potential to
most frequently admitted PBT to the intensive care unit benefit the healthcare system by reducing the overall cost
(ICU). ICU admission is often required for post-operative of care. Studies have shown that elective tumor resections
3
4-6
monitoring after craniotomy. While neurointensive care are associated with significantly lower costs and shorter
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unit (NICU) enables continuous monitoring and rapid hospital stays compared to emergent surgical procedures.
detection of neurological decline, the cost is expensive, With the rising costs of neurosurgical care, there is a
and bed availability is limited. In addition, not all patients pressing need to assess cost-effective strategies while
undergoing elective craniotomy benefit from routine post- promoting high-quality patient care. Despite advances in
operative ICU admission. Selective ICU admission could less invasive techniques, such as stereotactic radiosurgery,
7,8
address limited bed availability while reducing length of radiotherapy, and chemotherapy, surgical resection
stay (LOS) and overall costs. Patients requiring ICU care remains the standard of care for most PBTs. Traditionally,
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typically experience post-operative complications, such as ICU admission has been a routine practice for post-
acute respiratory failure necessitating advanced respiratory operative care following elective craniotomy. However, due
support to maintain adequate oxygenation. Other clinical to lack of standardization, recent studies have shown that
6
16
factors contributing to NICU admission include increased ICU-level of care may not be necessary for all patients.
intracranial pressure, seizures, compromised respiratory As a result, many hospitals have initiated non-ICU post-
support, hemodynamic instability, and other medical operative care pathways for elective craniotomy cases. This
comorbidities. 10 systematic review aims to synthesize and assess the existing
literature on outcomes and costs associated with non-ICU
Given the potential impact of ICU admission on post-operative care following elective craniotomy.
outcomes in elective craniotomies for PBT patients, it is
crucial to understand the factors contributing to ICU 3. Benefits of ICU care in patients with PBTs
admission and their association with outcomes. The undergoing surgery
purpose of this review is to synthesize and assess the
literature on outcomes, complications, and costs associated 3.1. Improved monitoring and care for post-
with post-operative ICU care for PBT patients undergoing operative complications
elective craniotomy. By reviewing the most updated ICU admission plays a crucial role in managing potential
evidence, this study provides healthcare professionals with complications in patients undergoing brain tumor
a better understanding of the potential risks and benefits surgery and offers various benefits. ICU admission
of ICU admission in this population, supporting informed following major surgery is considered the standard of
decision-making for optimal management and improve care in many healthcare systems around the world, as it
patient care and outcomes. enables rapid response to serious complications. 15,16 The
ICU provides access to specialized equipment such as
2. Importance of elective craniotomy in mechanical ventilators, continuous renal replacement
treatment therapy machines, continuous electroencephalogram, and
The goal of this review article is to evaluate the importance invasive hemodynamic monitoring devices, which might
of ICU admission after elective craniotomies for brain be essential for the care of these patients. In addition, the
tumors by analyzing relevant studies identified through ICU provides close monitoring of neurological status,
PubMed, Scopus, and Google Scholar. For many PBTs, pain management, and sedation to ensure patient comfort
surgical resection is often the initial treatment approach, and minimize discomfort. Studies have shown that
particularly in urgent cases where decompression is ICU admission after brain tumor surgery is associated
warranted. However, even in elective craniotomy cases, it with improved outcomes, including a reduced risk of
remains a frequently utilized primary therapeutic strategy. mortality, shorter hospital stays, and improved functional
17
The goal of surgery is to remove as many tumors as possible outcomes.
while minimizing damage to surrounding healthy brain Craniotomy, like all surgical procedures, carries the risk
tissue. Meanwhile, in the case of high-grade gliomas, of complications that can contribute to patient mortality,
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Volume 3 Issue 1 (2025) 2 doi: 10.36922/bh.3802