Details

Autor(en) / Beteiligte

• Azad, Tej D.
• Shah, Pavan P.
• Kannapadi, Nivedha
• Rincon Torroella, Jordina N.
• Xia, Yuanxuan
• Bernhardt, Lydia
• Hansen, Landon John
• Materi, Joshua
• Raj, Divyaansh
• Jackson, Christopher Mitchell
• Mukherjee, Raj
• Gallia, Gary L.
• Weingart, Jon
• Suarez, Jose
• Brem, Henry
• Bettegowda, Chetan

Titel

772 Re-examining the Role of Post-Operative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review

Ist Teil von

• Neurosurgery, 2023-04, Vol.69 (Supplement_1), p.37-37

Erscheinungsjahr

2023

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• INTRODUCTION: The standard-of-care for post-operative care following elective craniotomy has historically been intensive care unit (ICU) admission. However, recent literature interrogating complications and interventions during this post-operative ICU stay suggests that all patients may not require this level of care. Thus, hospitals began implementing non-ICU post-operative care pathways for elective craniotomy. METHODS: A systematic review of the PubMed database was performed following PRISMA guidelines from database inception through August 2021. Included studies were published in peer-reviewed journals, in English, and described outcomes for patients undergoing elective craniotomies without post-operative ICU care. Data regarding study design, patient characteristics, and post-operative care pathways was 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. RESULTS: In total, 1,131 unique papers were identified through the database search, with 27 meeting inclusion criteria. Included articles were published from 2001-2021 and included non-ICU inpatient care and same-day discharge pathways. Overall, the studies demonstrated that post-operative 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 (2.1%) patients intended for post-operative management in a non-ICU setting required subsequent care escalation. CONCLUSIONS: Overall, these studies suggest that non-ICU care pathways for appropriately selected post-craniotomy patients may represent a meaningful opportunity to improve care value. However, included studies varied greatly in patient selection, post-operative care protocol, and outcomes reporting. Standardization and multi-institutional collaboration are needed to draw definitive conclusions regarding non-ICU post-operative care for elective craniotomy.