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Brain & Heart ICU admission post-craniotomy for tumor

a successful rate of 92%. Only 11 patients were readmitted, that the LOS in the hospital was similar between patients
and none suffered any long-term morbidity attributable admitted to the ICU/MCU and those in the regular care
to early discharge. 60-62 Of the 41 patients (8%) who failed neurosurgical ward. Complications significantly reduced
to be discharged, the main reasons were new neurological after implementing the new policy, with an incidence
deficits postoperatively, followed by seizures. Another of 0.98 in cohort A (before the new policy) and 0.53 in
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study reported similar findings, with an 88.4% successful cohort B (after the new policy). Although the mean total
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discharge rate. These findings suggest that same-day LOS was one day shorter in cohort B, the difference was
discharge may be a viable option for selected patients, but not statistically significant. The average total cost per
careful patient selection is necessary to minimize the risk admission for cohorts A and B was €13,607 and €11,654,
of adverse outcomes. Future studies should investigate the respectively. These costs included surgery, hospital or ICU
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optimal selection criteria and the long-term outcomes of stays, lab fees, imaging, and consultations. However, cost
same-day discharge. 51 should not be the sole justification for lower acuity care
management after elective craniotomy. Patient safety and
Several studies have examined the safety and efficacy
of lower acuity settings for patients after elective medical considerations, such as the risks of side effects,
recovery times, and impact on quality of life, should also
craniotomy. In one study, the risk of complications was be considered. Another study described the immediate
evaluated in patients transferred from the PACU to the transfer to the floor resulted in a three-day reduction in
neurosurgery ward after a brief PACU stay. Only 4 patients average hospitalization length and provided cost savings
(1.1%) developed complications requiring transfer to the without compromising patient outcomes. Nevertheless,
ICU, none of whom died or suffered lasting disability. cost should not be the sole determining factor, and other
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Another study also reported that non-ICU care was safe medical considerations must be prioritized. Further
for these patients, with a shorter mean LOS compared research is needed to identify the most effective strategies
to those admitted to the ICU (3 vs. 7 days). However, for optimizing patient care while minimizing costs in
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further research is needed to determine appropriate neurosurgery.
patient selection criteria for non-ICU care and to assess
long-term outcomes. A study focused on enhanced 6. Evidence against the routine use of ICU
recovery after elective craniotomy, using the ERAS in this patient population
protocol highlighted the significant advantages of this
interdisciplinary approach over standard perioperative The patient population described here is the population
care. For patients undergoing craniotomies, the ERAS undergoing elective craniotomy for PBT resection.
protocol was linked to a considerable decrease in LOS, Many care centers admit these surgical patients to the
hospital expenses, and post-operative complications. ICU post-surgery, primarily to enable quicker diagnosis
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It is important to note that a study provides valuable of complications and prompt treatment. A study
insights into the safety and outcomes of post-operative reported that only 15% of patients required prolonged
admission to a regular step-down unit after elective ICU admission (more than one-day post-surgery) after
craniotomy, with a shorter LOS (7.0 days vs. 9.9 days). craniotomy for brain tumor resection. This portion
However, the study is limited by the fact that not all the of the patient population did not benefit from routine
patients in the cohort had PBTs. The study included ICU care and could have been transferred to the post-
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patients with a range of indications for craniotomy, operative neurosurgical floor for routine care instead. 65,66
including traumatic brain injury, vascular malformations, Another study, aligning with these findings, reported
and ventriculostomies. As such, the generalizability of the that only 16% of the patients required ICU services
findings to patients undergoing craniotomy specifically in the post-surgical period. The author emphasized
for PBTs may be limited. Future studies focused that the risk assessment and ICU admission policies
specifically on this population are necessary to further following brain tumor surgery should be based on
evaluate the safety and efficacy of lower acuity care objective, evidence-based measures rather than personal
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management. The cost of care is another major concern preferences or requests. In a study of 343 patients
for many healthcare centers. For example, the cost undergoing elective craniotomy, 43 planned and eight
differential between the NICU and the neurotransitional unplanned ICU admissions were recorded, which makes
care unit can be up to $1,500 per day. To analyze these a total of 51 patients (14%). These findings support the
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variables, a previous cohort study compared patients argument against routine ICU admission following
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who underwent craniotomy for supratentorial tumors elective craniotomy.
1 year after the introduction of a “no ICU, unless…” The existing scoring systems are not suitable for
policy with those from the year before. The study found most settings. Researchers claim that risk assessment

Volume 3 Issue 1 (2025) 7 doi: 10.36922/bh.3802