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. 2025 Jul 21.
doi: 10.1007/s12028-025-02323-z. Online ahead of print.

Postoperative Monitoring After Elective Intracranial Surgery in a Postanesthesia Care Unit is Safe, Efficient, and Cost-Effective

Arthur Wagner  1 , Alexander Quiring  1 , Anna Do  1 , Markus Heim  2 , Gerhard Schneider  2 , Bernhard Meyer  3
Affiliations

Postoperative Monitoring After Elective Intracranial Surgery in a Postanesthesia Care Unit is Safe, Efficient, and Cost-Effective

Arthur Wagner et al. Neurocrit Care. .

Abstract

Background: This study evaluates whether monitoring patients in the postanesthesia care unit (PACU) after elective intracranial surgery is as safe and effective as intensive care unit (ICU) monitoring, focusing on postoperative complications and resource use.

Methods: A retrospective cohort study was conducted at a tertiary academic hospital, analyzing patients who underwent elective craniotomies from March 2013 to September 2023. Patients were allocated to PACU or ICU monitoring based on preoperative risk assessment and intraoperative events. Outcomes measured included complication rates, revision surgeries within 72 h, transfers from PACU to ICU, and ICU resource use.

Results: A total of 5638 consecutive patients (mean age 54 years, 56% female) were analyzed, of whom 96.0% were monitored in the PACU, whereas 3.7% required ICU admission due to high-risk conditions or intraoperative events. The early complication rate in PACU-monitored patients was 17.1%, with most complications occurring within the first 13.2 h (SD 17.0) post surgery. Revision surgery was required in 4.6% of cases, and transfers from the PACU to the ICU occurred in 1.9%. PACU monitoring reduced ICU use by 94.4% compared to an all-ICU strategy, with no compromise in safety or outcomes.

Conclusions: PACU-based monitoring is a safe and efficient alternative to ICU care for elective craniotomy patients, offering comparable complication rates and outcomes. This approach significantly reduces ICU demand, providing a cost-effective strategy that optimizes critical care resources while maintaining patient safety.

Keywords: Complication management; Intensive care unit; Postanesthesia care unit; Postoperative monitoring; Resource use.

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Conflict of interest statement

Declarations. Conflicts of Interest: No pertinent conflicts of interest to report for this study. Ethical Approval/Informed Consent: The need for written informed consent was waived by the local ethics committee (institutional review board reference number: 5626-12).

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