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Hoffman SE, Gupta S, O'Connor M, Jarvis CA, Zhao M, Hauser BM, Bernstock JD, Murphy S, Raftery SM, Lane K, Chiocca EA, Arnaout O. Reduced time to imaging, length of stay, and hospital charges following implementation of a novel postoperative pathway for craniotomy. J Neurosurg 2023; 139:373-384. [PMID: 36609368 PMCID: PMC10904334 DOI: 10.3171/2022.12.jns222123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The authors created a postoperative postanesthesia care unit (PACU) pathway to bypass routine intensive care unit (ICU) admissions of patients undergoing routine craniotomies, to improve ICU resource utilization and reduce overall hospital costs and lengths of stay while maintaining quality of care and patient satisfaction. In the present study, the authors evaluated this novel PACU-to-floor clinical pathway for a subset of patients undergoing craniotomy with a case time under 5 hours and blood loss under 500 ml. METHODS A single-institution retrospective cohort study was performed to compare 202 patients enrolled in the PACU-to-floor pathway and 193 historical controls who would have met pathway inclusion criteria. The pathway cohort consisted of all adult supratentorial brain tumor cases from the second half of January 2021 to the end of January 2022 that met the study inclusion criteria. Control cases were selected from the beginning of January 2020 to halfway through January 2021. The authors also discuss common themes of similar previously published pathways and the logistical and clinical barriers overcome for successful PACU pathway implementation. RESULTS Pathway enrollees had a median age of 61 years (IQR 49-69 years) and 53% were female. Age, sex, pathology, and American Society of Anesthesiologists physical status distributions were similar between pathway and control patients (p > 0.05). Most of the pathway cases (96%) were performed on weekdays, and 31% had start times before noon. Nineteen percent of pathway patients had 30-day readmissions, most frequently for headache (16%) and syncope (10%), whereas 18% of control patients had 30-day readmissions (p = 0.897). The average time to MRI was 6 hours faster for pathway patients (p < 0.001) and the time to inpatient physical therapy and/or occupational therapy evaluation was 4.1 hours faster (p = 0.046). The average total length of stay was 0.7 days shorter for pathway patients (p = 0.02). A home discharge occurred in 86% of pathway cases compared to 81% of controls (p = 0.225). The average total hospitalization charges were $13,448 lower for pathway patients, representing a 7.4% decrease (p = 0.0012, adjusted model). Seven pathway cases were escalated to the ICU postoperatively because of attending physician preference (2 cases), agitation (1 case), and new postoperative neurological deficits (4 cases), resulting in a 96.5% rate of successful discharge from the pathway. In bypassing the ICU, critical care resource utilization was improved by releasing 0.95 ICU days per patient, or 185 ICU days across the cohort. CONCLUSIONS The featured PACU-to-floor pathway reduces the stay of postoperative craniotomy patients and does not increase the risk of early hospital readmission.
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Sangtongjaraskul S, Lerdsirisopon S, Sae-phua V, Kanta S, Kongkiattikul L. Factors Influencing Prolonged Intensive Care Unit Length of Stay after Craniotomy for Intracranial Tumor in Children: A 10-year Analysis from a University Hospital. Indian J Crit Care Med 2023; 27:205-211. [PMID: 36960121 PMCID: PMC10028711 DOI: 10.5005/jp-journals-10071-24418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 03/05/2023] Open
Abstract
Background Postoperative intensive care unit (ICU) admission is routinely practiced in pediatric and adult craniotomy. This study aims to identify the factors associated with an ICU stay of more than one day (prolonged ICU stay, PIS) after pediatric brain tumor surgery. Methods Medical records of children who underwent craniotomy for brain tumor during a 10-year period were reviewed and analyzed. Perioperative variables were examined and compared between the one-day ICU stay (ODIS) and PIS groups. Results A total of 314 craniotomies performed on 302 patients was included. Patients requiring postoperative ICU care for more than a day represented 37.9% of the sample. Significant factors found in the multivariate analysis affecting prolonged ICU length of stay included operative time ≥360 minutes (adjusted odds ratio [AOR], 2.438; 95% confidence interval [CI]: 1.223-4.861; p = 0.011), presence of an endotracheal (ET) tube (AOR, 7.469; 95% CI: 3.779-14.762; p < 0.001), and external ventricular drain (EVD) at ICU admission (AOR, 2.512; 95% CI: 1.458-4.330; p = 0.001). Conclusion While most children undergoing a craniotomy for brain tumor need a postoperative ICU care of ≤1 day, slightly more than a one-third in our study stayed longer. The prediction of a PIS can be beneficial for optimal resource utilization, increasing ICU bed turnover rate, reduction of operation cancellation, and improved preparation for parent expectations. How to cite this article Sangtongjaraskul S, Lerdsirisopon S, Sae-phua V, Kanta S, Kongkiattikul L. Factors Influencing Prolonged Intensive Care Unit Length of Stay after Craniotomy for Intracranial Tumor in Children: A 10-year Analysis from a University Hospital. Indian J Crit Care Med 2023;27(3):205-211.
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Affiliation(s)
- Sunisa Sangtongjaraskul
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Sunisa Sangtongjaraskul, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand, Phone: +66935569556, e-mail:
| | | | - Vorrachai Sae-phua
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sukanya Kanta
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Lalida Kongkiattikul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Hatipoglu Majernik G, Wolff Fernandes F, Al-Afif S, Heissler HE, Palmaers T, Atallah O, Scheinichen D, Krauss JK. Routine postoperative admission to the neurocritical intensive care unit after microvascular decompression: necessary or can it be abandoned? Neurosurg Rev 2022; 46:12. [PMID: 36482263 PMCID: PMC9732061 DOI: 10.1007/s10143-022-01910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
Postoperative neurocritical intensive care unit (NICU) admission of patients who underwent craniotomy for close observation is common practice. In this study, we performed a comparative analysis to determine if there is a real need for NICU admission after microvascular decompression (MVD) for cranial nerve disorders or whether it may be abandoned. The present study evaluates a consecutive series of 236 MVD surgeries performed for treatment of trigeminal neuralgia (213), hemifacial spasm (17), vagoglossopharyngeal neuralgia (2), paroxysmal vertigo (2), and pulsatile tinnitus (2). All patients were operated by the senior surgeon according to a standard protocol over a period of 12 years. Patients were admitted routinely to NICU during the first phase of the study (phase I), while in the second phase (phase II), only patients with specific indications would go to NICU. While 105 patients (44%) were admitted to NICU postoperatively (phase I), 131 patients (56%) returned to the ward after a short stay in a postanaesthesia care unit (PACU) (phase II). Specific indications for NICU admission in phase I were pneumothorax secondary to central venous catheter insertion (4 patients), AV block during surgery, low blood oxygen levels after extubation, and postoperative dysphagia and dysphonia (1 patient, respectively). There were no significant differences in the distribution of ASA scores or the presence of cardiac and pulmonary comorbidities like congestive heart failure, arterial hypertension, or chronic obstructive pulmonary disease between groups. There were no secondary referrals from PACU to NICU. Our study shows that routine admission of patients after eventless MVD to NICU does not provide additional value. NICU admission can be restricted to patients with specific indications. When MVD surgery is performed in experienced hands according to a standard anaesthesia protocol, clinical observation on a neurosurgical ward is sufficient to monitor the postoperative course. Such a policy results in substantial savings of costs and human resources.
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Affiliation(s)
- Gökce Hatipoglu Majernik
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Filipe Wolff Fernandes
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Thomas Palmaers
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Dirk Scheinichen
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Finneran MM, Graber S, Poppleton K, Alexander AL, Wilkinson CC, O'Neill BR, Hankinson TC, Handler MH. Postoperative general medical ward admission following Chiari malformation decompression. J Neurosurg Pediatr 2022; 30:602-608. [PMID: 36115060 DOI: 10.3171/2022.7.peds22226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/29/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prior to 2019, the majority of patients at Children's Hospital Colorado were admitted to the pediatric intensive care unit (PICU) following Chiari malformation (CM) decompression surgery. This study sought to identify the safety and efficacy of postoperative general ward management for these patients. METHODS After a retrospective baseline assessment of 150 patients, a quality improvement (QI) initiative was implemented, admitting medically noncomplex patients to the general ward postoperatively following CM decompression. Twenty-one medically noncomplex patients were treated during the QI intervention period. All patients were assessed for length of stay, narcotic use, time to ambulation, and postoperative complications. RESULTS PICU admission rates postoperatively decreased from 92.6% to 9.5% after implementation of the QI initiative. The average hospital length of stay decreased from 3.4 to 2.6 days, total doses of narcotic administration decreased from 12.3 to 8.7, and time to ambulation decreased from 1.8 to 0.9 days. There were no major postoperative complications identified that were unsuitable for management on a conventional pediatric medical/surgical nursing unit. CONCLUSIONS Medically noncomplex patients were safely admitted to the general ward postoperatively at Children's Hospital Colorado after decompression of CM. This approach afforded decreased length of stay, decreased narcotic use, and decreased time to ambulation, with no major postoperative complications.
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Affiliation(s)
- Megan M Finneran
- 1Department of Neurosurgery, Carle BroMenn Medical Center, Normal, Illinois
| | - Sarah Graber
- 2Research Institute, Children's Hospital Colorado, Aurora
- 3Department of Neurosurgery, Children's Hospital Colorado, Aurora; and
| | - Kim Poppleton
- 2Research Institute, Children's Hospital Colorado, Aurora
| | - Allyson L Alexander
- 3Department of Neurosurgery, Children's Hospital Colorado, Aurora; and
- 4Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - C Corbett Wilkinson
- 3Department of Neurosurgery, Children's Hospital Colorado, Aurora; and
- 4Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Brent R O'Neill
- 3Department of Neurosurgery, Children's Hospital Colorado, Aurora; and
- 4Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Todd C Hankinson
- 3Department of Neurosurgery, Children's Hospital Colorado, Aurora; and
- 4Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael H Handler
- 3Department of Neurosurgery, Children's Hospital Colorado, Aurora; and
- 4Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
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Reexamining the Role of Postoperative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review. Crit Care Med 2022; 50:1380-1393. [PMID: 35686911 DOI: 10.1097/ccm.0000000000005588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The standard-of-care for postoperative care following elective craniotomy has historically been ICU admission. However, recent literature interrogating complications and interventions during this postoperative ICU stay suggests that all patients may not require this level of care. Thus, hospitals began implementing non-ICU postoperative care pathways for elective craniotomy. This systematic review aims to summarize and evaluate the existing literature regarding outcomes and costs for patients receiving non-ICU care after elective craniotomy. DATA SOURCES A systematic review of the PubMed database was performed following PRISMA guidelines from database inception to August 2021. STUDY SELECTION Included studies were published in peer-reviewed journals, in English, and described outcomes for patients undergoing elective craniotomies without postoperative ICU care. DATA EXTRACTION Data regarding study design, patient characteristics, and postoperative care pathways were extracted independently by two authors. Quality and risk of bias were evaluated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence tool and Risk Of Bias In Non-Randomized Studies-of Interventions tool, respectively. DATA SYNTHESIS In total, 1,131 unique articles were identified through the database search, with 27 meeting inclusion criteria. Included articles were published from 2001 to 2021 and included non-ICU inpatient care and same-day discharge pathways. Overall, the studies demonstrated that postoperative non-ICU care for elective craniotomies led to length of stay reduction ranging from 6 hours to 4 days and notable cost reductions. Across 13 studies, 53 of the 2,469 patients (2.1%) intended for postoperative management in a non-ICU setting required subsequent care escalation. CONCLUSIONS Overall, these studies suggest that non-ICU care pathways for appropriately selected postcraniotomy patients may represent a meaningful opportunity to improve care value. However, included studies varied greatly in patient selection, postoperative care protocol, and outcomes reporting. Standardization and multi-institutional collaboration are needed to draw definitive conclusions regarding non-ICU postoperative care for elective craniotomy.
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Munari M, De Cassai A, Sandei L, Correale C, Calandra S, Iori D, Geraldini F, Vitalba A, Grandis M, Chioffi F, Navalesi P. Optimizing post anesthesia care unit admission after elective craniotomy for brain tumors: a cohort study. Acta Neurochir (Wien) 2022; 164:635-641. [PMID: 33517465 DOI: 10.1007/s00701-021-04732-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative admission to intensive care unit (ICU) after craniotomy for brain tumor was the routine in the past years. However, there is little evidence supporting this dogma and doubts have been casted by many authors in the last years. Our aim was to identify risk factors for ICU admission after elective brain tumor surgery in order to propose an individualized admission to ICU tailored on patient needs. METHODS We conducted a retrospective cohort study including all patients undergoing elective surgery for brain tumor in a neurosurgical post anesthesia care unit of a university hospital over a period of 6 years. In order to identify and validate risk factors for ICU admission, we split the final cohort of patients in a training cohort (two/third of the cohort) and the validation cohort (one/third of the cohort) using a random sequence. Using univariate and multivariate logistic regression, we created a scoring system in the training cohort and tested it with the validation cohort. Moreover, we perform a sensitivity analysis on the overall population. RESULTS A total of 420 patients were eligible for this study. ASA-PS, tumor volume, and surgery length entered the scoring system. Sensitivity analysis on the overall population for the scoring system had an AUC of 0.774 (95% CI 0.668-0.880, the best threshold at 12.5) CONCLUSIONS: We created a tool based on ASA-PS, length of surgery, and tumor volume to evaluate the risk for ICU admission after supratentorial tumor resection. Prospective studies are deemed necessary to validate our tool.
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Affiliation(s)
- Marina Munari
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, via Giustiniani 2, 35128, Padua, Italy
| | - Alessandro De Cassai
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, via Giustiniani 2, 35128, Padua, Italy.
| | - Ludovica Sandei
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | | | | | - Davide Iori
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | | | | | - Marzia Grandis
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, via Giustiniani 2, 35128, Padua, Italy
| | - Franco Chioffi
- Department of Neurosurgery, University Hospital of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, via Giustiniani 2, 35128, Padua, Italy
- Department of Medicine-DIMED, University of Padua, Padua, Italy
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Williamson CA. Shedding a Little Light on the Need for Scheduled ICU Admission Following Endovascular Treatment of Unruptured Intracranial Aneurysm. Neurocrit Care 2021; 36:16-17. [PMID: 34331203 PMCID: PMC8324434 DOI: 10.1007/s12028-021-01316-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Craig A Williamson
- Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. .,Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
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Padmanaban V, Gigliotti M, Majid S, Jareczek FJ, Fritch C, Hazard SW, Zacko JC, Simon SD, Kalapos P, Church EW, Wilkinson DA, Cockroft KM. Risk Factors Associated with ICU-Specific Care in Patients Undergoing Endovascular Treatment of Unruptured Intracranial Aneurysms. Neurocrit Care 2021; 36:39-45. [PMID: 34309785 DOI: 10.1007/s12028-021-01306-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multiple studies suggest routine postoperative intensive care unit (ICUs) stays in presumed high-risk neurosurgical procedures may be unnecessary. Our objective was to evaluate the risk factors associated with ICU-specific needs in patients undergoing elective endovascular treatment of unruptured intracranial aneurysms. METHODS A retrospective review of consecutive patients undergoing elective endovascular treatment of unruptured aneurysms was performed between January 2010 and January 2020 in a single academic medical center. Patient demographic information, aneurysm and treatment characteristics, intraoperative and postoperative complications, as well as ICU-specific needs, were abstracted. The primary outcome was ICU-specific needs. RESULTS A total of 382 patient encounters in 344 unique patients were abstracted. 13.6% (52 of 382) of patient encounters had an ICU-specific need. Multivariate analysis revealed that age [adjusted odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07, p = 0.03], procedure duration greater 200 min (adjusted OR 2.75, 95% CI 1.34-5.88, p = 0.007), and any intraoperative complication (adjusted OR 20.41, CI 7.97-56.57, p < 0.001) were independent predictors of postoperative ICU-specific needs. The majority of ICU-specific needs (94%, 49 of 52) occurred within 6 h of surgery. CONCLUSIONS Our results show that age, procedure duration greater than or equal to 200 min, and intraoperative complication were independent predictors of postoperative ICU-specific needs in patients presenting for elective endovascular treatment of unruptured intracranial aneurysms. The majority of ICU-specific needs and associated complications occurred in the immediate postoperative period. This data can be used to help decide the appropriate postoperative level of care in this patient population.
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Affiliation(s)
- Varun Padmanaban
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Michael Gigliotti
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Sonia Majid
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Francis J Jareczek
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Chanju Fritch
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Sprague W Hazard
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA.,Department of Anesthesia and Perioperative Services, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - J Christopher Zacko
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Scott D Simon
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Paul Kalapos
- Department of Radiology, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ephraim W Church
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - D Andrew Wilkinson
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Kevin M Cockroft
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA. .,Department of Radiology, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. .,Department of Public Health Services, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
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Bonfield CM, Basem J, Cochrane DD, Singhal A, Steinbok P. Examining the need for routine intensive care admission after surgical repair of nonsyndromic craniosynostosis: a preliminary analysis. J Neurosurg Pediatr 2018; 22:616-619. [PMID: 30239283 DOI: 10.3171/2018.6.peds18136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAt British Columbia Children's Hospital (BCCH), pediatric patients with nonsyndromic craniosynostosis are admitted directly to a standard surgical ward after craniosynostosis surgery. This study's purpose was to investigate the safety of direct ward admission and to examine the rate at which patients were transferred to the intensive care unit (ICU), the cause for the transfer, and any patient characteristics that indicate higher risk for ICU care.METHODSThe authors retrospectively reviewed medical records of pediatric patients who underwent single-suture or nonsyndromic craniosynostosis repair from 2011 to 2016 at BCCH. Destination of admission from the operating room (i.e., ward or ICU) and transfer to the ICU from the ward were evaluated. Patient characteristics and operative factors were recorded and analyzed.RESULTSOne hundred fourteen patients underwent surgery for single-suture or nonsyndromic craniosynostosis. Eighty surgeries were open procedures (cranial vault reconstruction, frontoorbital advancement, extended-strip craniectomy) and 34 were minimally invasive endoscope-assisted craniectomy (EAC). Sutures affected were sagittal in 66 cases (32 open, 34 EAC), coronal in 20 (15 unilateral, 5 bilateral), metopic in 23, and multisuture in 5. Only 5 patients who underwent open procedures (6%) were initially admitted to the ICU from the operating room; the reasons for direct admission were as follows: the suggestion of preoperative elevated intracranial pressure, pain control, older-age patients with large reconstruction sites, or a significant medical comorbidity. Overall, of the 107 patients admitted directly to the ward (75 who underwent an open surgery, 32 who underwent an EAC), none required ICU transfer.CONCLUSIONSOverall, the findings of this study suggest that patients with nonsyndromic craniosynostosis can be managed safely on the ward and do not require postoperative ICU admission. This could potentially increase cost savings and ICU resource utilization.
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Affiliation(s)
- Christopher M Bonfield
- 1Department of Neurological Surgery; and
- 2Surgical Outcomes Center for Kids, Vanderbilt University, Nashville, Tennessee; and
| | - Jade Basem
- 2Surgical Outcomes Center for Kids, Vanderbilt University, Nashville, Tennessee; and
| | - D Douglas Cochrane
- 3Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ash Singhal
- 3Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Paul Steinbok
- 3Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
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Karsy M, Guan J, Abou-Al-Shaar H, Eli IM, Kundu B, Bisson EF, Couldwell WT, Dossani RH. Letter to the Editor. Effect of facility costs in the treatment of neurosurgical patients using the Value Driven Outcome database. J Neurosurg 2018; 129:841-842. [DOI: 10.3171/2018.3.jns18725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mirza FA, Wang C, Pittman T. Can patients safely be admitted to a ward after craniotomy for resection of intra-axial brain tumors? Br J Neurosurg 2017; 32:201-205. [DOI: 10.1080/02688697.2017.1390064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Farhan A. Mirza
- Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
| | - Catherine Wang
- Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
| | - Thomas Pittman
- Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
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