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  • Post-Operative ICU Admission for Elective Craniotomy for Intra-axial Brain Tumor Resection

    Final Number:

    Farhan A Mirza MD; Catherine Y Wang BASc; Thomas Pittman MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: We reviewed our practice at the University of Kentucky in order to assess the safety of admitting adult and pediatric patients to floor beds after craniotomy, exclusively for intra-axial brain tumor resection.

    Methods: Retrospective chart review of patients, adults and pediatric, who underwent craniotomy by a single surgeon (TP) for intra axial brain tumor resection between January 2012 and December 2015. 413 patient charts were reviewed, 16 were omitted due to incomplete records.

    Results: 421 craniotomies for intra axial brain tumor resection were performed. 397 patients underwent surgery, 35 of whom were <18 years of age.188 females and 209 males. 351 patients (331 adults, 20 pediatric) were admitted to floor beds. In this group, length of operation was <4 hours in 346 patients (99.1%) and >4 hours in only 5 patients (0.9%). 3 patients (0.8%) required transfer to ICU within 24 hours of floor admission. 55 adult patients required ICU stay for various reasons: 9 patients had pre-operative or intra operative EVD placement; 15 patients required prolonged ventilation; 1 patient had to be taken back to the operating room for hemorrhage evacuation; 5 had intraventricular tumors and were planned ICU admissions; 26 patients were admitted pre-operatively to an ICU bed on a non neurosurgical service and were returning to their assigned beds. In the pediatric population, 15 patients required ICU stay: 8 were for EVD management and 7 for prolonged operation or frequent neurological evaluations. In this group, the length of operation was <4 hours in 40 patients(57.1%) and >4 hours in 30 patients (42.9%).

    Conclusions: Admitting adult and pediatric patients to floor beds after craniotomy for intra-axial brain tumor resection is safe. There are some conditions that mandate ICU admission: these include prolonged mechanical ventilation and the presence of an external ventricular drain.

    Patient Care: Our study highlights the safe practice of admitting patients to floor beds who have undergone craniotomy for resection of an intra-axial brain tumor. This is in contrast to the practice of admitting all patients to an ICU bed for close monitoring after the same procedure. It also reflects on efficient resource utilization in this day and age of rising healthcare costs.

    Learning Objectives: By the conclusion of this session, the participants should be able to understand the safety of admitting patients to a regular floor bed after craniotomy for intra axial brain tumor resection.

    References: 1. Bui JQ, Mendis RL, van Gelder JM, Sheridan MM, Wright KM, Jaeger M. Is postoperative intensive care unit admission a prerequisite for elective craniotomy? J Neurosurg. 115(6):1236-41, 2011 2. Ziai WC, Varelas PN, Zeger SL, Mirski MA, Ulatowski JA.Neurologic intensive care resource use after brain tumor surgery: an analysis of indications and alternative strategies. Crit Care Med 31(12):2782-7, 2003 3. Beauregard CL, Friedman WA. Routine use of postoperative ICU care for elective craniotomy: a cost-benefit analysis. Surg Neurol 60:483–9, 2003 4. Bernstein M: Outpatient craniotomy for brain tumor: a pilot feasibility study in 46 patients. Can J Neurol Sci 28:120–124, 2001 5. Boulton M, Bernstein M: Outpatient brain tumor surgery: innovation in surgical neurooncology. J Neurosurg 108:649–654, 2008 6. Grundy PL, Weidmann C, Bernstein M: Day-case neurosurgery for brain tumors: the early United Kingdom experience. Br J Neurosurg 22:360–367, 2008

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