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Brain & Heart ICU admission post-craniotomy for tumor

Figure 1. The current approach to post-operative care in elective craniotomy
Abbreviations: ICU: Intensive care unit.

4. Limitations and risks associated with ICU approximately 30% of HAIs occurring in the ICU. Post-
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use operative critical care is associated with an increased risk
of HAIs. Although infections in neurosurgical procedures
4.1. Financial burden and limited resources are uncommon, certain factors can predispose patients
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Healthcare system costs are constantly rising. Although to surgical site infections. In a study of 317 patients
41
the ICU provides highly specialized patient care that is undergoing cranial neurosurgery, the overall infection rate
crucial for survival in selected cases, it often represents was 7.2%, with most infections associated with the use of
a significant economic burden. The lack of studies extra-ventricular drainage. However, extra-ventricular
examining ICU cost-effectiveness highlights the need drainage is usually unnecessary in elective brain tumor
for careful patient selection. 42,43 Craniotomies alone are surgery. In these cases, infections are normally caused by
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41
associated with high healthcare costs, and the addition skin flora, most commonly Staphylococcus. The bone flaps
of ICU monitoring and management postoperatively can created for cerebral access are avascular, making them prone
further increase the financial burden. 44 to necrosis, inflammation, and post-operative infection.
One effective strategy to address this challenge is an Preferred management includes surgical debridement
outpatient craniotomy, which has been correlated with a and removal of the bone flap with antimicrobial therapy.
radical reduction in care costs when compared to inpatient While the optimal duration of antibiotic treatment is not
craniotomy. Compared to outpatient care, inpatient well defined, most studies suggest a range of 6 weeks to
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procedures have been shown to incur an approximately six 12 months. 37
times higher costs per unit/bed, whereas operating room, 4.3. Potential for adverse reactions to medication
laboratory, and anesthesia expenses showed comparable and treatments
cost differences across intervention settings. Accordingly,
outpatient-based neurosurgical brain tumor resection emerge Post-operative management of patients undergoing
as a safe and reasonable treatment option for appropriately craniotomy usually includes: (1) pain management,
selected patients, offering substantial global cost benefits. 45-48 (2) optimization of the PONV approach, (3) early oral
nutrition with gastrointestinal protection, (4) proper
4.2. Increased risk of infection and prolonged catheter management, and (5) early mobilization. These
hospital stays recommendations can be tailored to individual patient
HAIs are a major public healthcare burden associated needs. 52-54 However, adverse reactions to post-operative
with more than 140,000 deaths worldwide each year, with management can affect patient prognosis and survival.

Volume 3 Issue 1 (2025) 5 doi: 10.36922/bh.3802