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Brain & Heart ICU admission post-craniotomy for tumor

increase healthcare costs, and complicate the management stays, and minimize the risk of secondary infections. 33,34
of recovery. Understanding potential complications To summarize, complications requiring ICU treatment
allows healthcare professionals to monitor patients more mainly include acute respiratory failure, seizures, and
effectively and guide decision-making for optimal care. hemorrhages. Failure to manage these complications
These complications have been reported in several studies, may lead to increased mortality, which could be notably
as summarized in Table 1. 11,18-24 reduced if patients are transferred to the ICU from the
post-anesthetic care unit (PACU). 35
In patients undergoing elective craniotomy for brain
tumor surgery, complications are common due to the 3.2. The current approach to post-operative care in
psychological, physiological, and emotional burdens elective craniotomy
patients experience before, during, and after surgery. 18,25,26
Post-operative complications can be severe and represent Over the years, the approach to post-operative ICU care
important causes of morbidity and mortality following following elective craniotomy has changed in considerable
brain tumor surgery. Continuous monitoring during the ways. While articles published over the last decade
first 24 h is critical for the prompt diagnosis and treatment have suggested the importance of close monitoring
36
of complications. 27,28 in the ICU, the current approach is slowly evolving
to emphasize individualized patient evaluation. This
Complications following elective craniotomy for PBT approach assesses the need for post-operative ICU care,
surgery can be neurological, hemodynamic, metabolic, or given the absence of standardized guidelines. Some
7
respiratory. Among these, common complications include studies have shown empiric protocols recommending
post-operative nausea and vomiting (PONV), new motor that patients be directly transferred to the ICU to monitor
deficits, and hemodynamic instability. 11,15,20,25-27,29,30 The for post-operative complications within 24 h of surgery,
risk and severity of these complications can depend on even if they are considered low risk in accordance to the
individual factors such as age and comorbidities, which American Society of Anesthesiologists Physical Status
may lead to worse survival rates. 31 I and II. Proposed criteria for ICU admission include
Neurological complications following elective preoperative altered consciousness, surgical durations
craniotomy can occur frequently. Up to a third of patients, longer than 4 h, and intraoperative complications such
especially those with infiltrative tumors like glioblastomas as hypotension, post-operative malignant edema, severe
may develop new motor deficits. While post-operative blood loss, hemodynamic instability, and lateral surgical
33,37
seizures are relatively rare, they are among the most feared positioning, among others. In addition, 30% of
complications due to their potential effects on a patient’s neurologic complications are more frequent in the post-
38
recovery. Another serious issue is intracranial hemorrhage, operative than in the perioperative period. Nevertheless,
with incidences varying from 0.8% to 50.0%. This is it is crucial to identify risk factors that may compromise
particularly common after brain tumor surgery, where patient outcomes. In some cases, patients may only require
acute post-operative hypertension can play a significant role basic nursing care, signs period monitoring, and first-
instance interventions based on post-surgical procedure
in its development. Despite the potential for emergency
21
hematoma evacuation, the mortality rate remains high at symptoms, while others may need intensive monitoring
39
around 30%, making it the leading cause of death after for unexpected complications.
cranial surgery. Reports on the most frequent causes of Another crucial benefit of admitting post-craniotomy
26
complications after craniotomy are heterogeneous in the patients to the ICU allows for early detection of serious
literature. Some studies suggest that PONV are the most post-operative complications, facilitating timely diagnosis
37
common complications, typically occurring within the and treatment along with optimizing recovery. However,
first 24 hours after surgery. current literature advocates that non-ICU level care may
be appropriate in certain cases, especially for patients who
Conversely, Decavèle et al. reported that the most are at risk of healthcare-associated infections (HAIs),
32
predominant complication in their population was which can be more easily contracted in the ICU. In
40
respiratory failure, which may be associated with specific addition, ICU care beyond 4 h may not provide significant
anesthetic processes. To clarify these heterogeneous additional benefits. Patients who do not require lateral
findings, larger observational studies are needed.
positioning during neurosurgery and those who are
Evidence suggests that many of these complications successfully extubated within 4 h postoperatively may
can be managed at the intermediate care level and, meet the criteria to avoid ICU admission. Figure 1
37
in select cases, at the ICU level. Understanding these depicts the current approach to post-operative care in
complications may help reduce costs, shorten hospital elective craniotomy.

Volume 3 Issue 1 (2025) 3 doi: 10.36922/bh.3802