Introduction: Early post-operative CT scanning after elective craniotomy is commonly performed to assess surgical results and for early detection of complications. Although commonplace, this practice exposes the patient to radiation and is an extra cost that may not be warranted. The purpose of this study was to see if there is any information gained from post-operative CT, after elective craniotomy that led to a surgical intervention.
Methods: A retrospective review of a prospectively collected database of all elective craniotomies done at a single institution over a 12 month period, and with an early post-operative CT scan. Primary endpoint was need for a surgical intervention (return to operating room, or placement of an external ventricular drain). Post-operative neurologic exams, age, pre-operative labs, location of surgery, pathology, and time from end of surgery to CT scan were analyzed.
Results: 236 patients had elective craniotomies performed with an early post-operative scan. One patient (0.4%) needed return to the OR based on imaging findings and exam. Imaging studies were categorized as 1) no complication, 2) blood in resection cavity, 3) intraventricular hemorrhage, 4) hematoma, 5) subarachnoid hemorrhage, and 6) subdural hematoma. There was no significant difference between CT scan findings and the primary or secondary endpoints. No association between post-operative neurologic examination (baseline, expected deficit, unexplained deficit) and imaging results was seen. A conservative estimate of the total cost was $46,975.
Conclusions: A post-operative CT scan after elective craniotomy does not correlate with neurologic outcome. Abnormal findings are common, but these do not lead to surgical intervention and poorly detect complications. It is unnecessary in non-comatose patients; and the neurologic exam can be used to monitor post-operative complications, where an unexpected decline in status should prompt imaging studies to be performed.
Patient Care: Avoidance of unnecessary medical costs to both the patient and hospital, and avoid radiation to the patient.
Learning Objectives: By the conclusion of this session, participants should be able to 1) see that performing routine and regular neurologic examinations after surgery is a reliable proxy for intracranial complications, 2)new imaging findings after surgery does not correlate with neurologic deficits or surgical complication, and 3) discuss if the medical cost and exposure to unnecessary radiation is unwarranted.