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. 2022 Sep 1;50(9):1380-1393.
doi: 10.1097/CCM.0000000000005588. Epub 2022 Jun 10.

Reexamining the Role of Postoperative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review

Tej D Azad  1 , Pavan P Shah  1 , Nivedha V Kannapadi  1 , Jordina Rincon-Torroella  1 , Yuanxuan Xia  1 , Lydia J Bernhardt  1 , Landon J Hansen  1 , Joshua Materi  1 , Divyaansh Raj  1 , Christopher M Jackson  1 , Debraj Mukherjee  1 , Gary L Gallia  1 , Jon Weingart  1 , Jose I Suarez  2 , Henry Brem  1 , Chetan Bettegowda  1
Affiliations

Reexamining the Role of Postoperative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review

Tej D Azad et al. Crit Care Med. .

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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Conflict of interest statement

Dr. Rincon-Torroella’s institution received funding from the National Institute of Neurological Disorders and Stroke (R25 grant holder [5R25NS065729]); she received support for article research from the National Institutes of Health (NIH). Dr. Jackson received funding from Boehringer Laboratories and Egret Therapeutics. Dr. Brem received funding from the NIH, Johns Hopkins University, Arbor Pharmaceuticals, and Bristol-Myers Squibb; he disclosed that he is a consultant for AcuityBio Corp., InSightec, Accelerating Combination Therapies, Catalio Nexus Fund II, CraniUS, Candel Therapeutics, LikeMinds, Galen Robotics, Nurami Medical, AsclepiX Therapeutics, and StemGen. Dr. Bettegowda disclosed that he is a consultant for Depuy-Synthes, Bionaut Labs, and Galectin Therapeutics. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

    1. Smith TR, Rambachan A, Cote D, et al.: Market-based health care in specialty surgery: Finding patient-centered shared value. Neurosurgery 2015; 77:509–516; discussion 516
    1. McLaughlin N, Upadhyaya P, Buxey F, et al.: Value-based neurosurgery: Measuring and reducing the cost of microvascular decompression surgery. J Neurosurg 2014; 121:700–708
    1. Menger RP, Guthikonda B, Storey CM, et al.: Neurosurgery value and quality in the context of the Affordable Care Act: A policy perspective. Neurosurg Focus 2015; 39:E5
    1. Mooney MA, Yoon S, Cole T, et al.: Cost transparency in neurosurgery: A single-institution analysis of patient out-of-pocket spending in 13 673 consecutive neurosurgery cases. Neurosurgery 2019; 84:1280–1289
    1. Regenbogen SE, Cain-Nielsen AH, Norton EC, et al.: Costs and consequences of early hospital discharge after major inpatient surgery in older adults. JAMA Surg 2017; 152:e170123

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