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The Utility of Routine Intensive Care Admission for Patients Undergoing Intracranial Neurosurgical Procedures: A Systematic Review

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Abstract

Background

Patients who have undergone intracranial neurosurgical procedures have traditionally been admitted to an intensive care unit (ICU) for close postoperative neurological observation. The purpose of this study was to systematically review the evidence for routine ICU admission in patients undergoing intracranial neurosurgical procedures and to evaluate the safety of alternative postoperative pathways.

Methods

We were interested in identifying studies that examined selected patients who presented for elective, non-emergent intracranial surgery whose postoperative outcomes were compared as a function of ICU versus non-ICU admission. A systematic review was performed in July 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist of the Medline database. The search strategy was created based on the following key words: “craniotomy,” “neurosurgical procedure,” and “intensive care unit.”

Results

The nine articles that satisfied the inclusion criteria yielded a total of 2227 patients. Of these patients, 879 were observed in a non-ICU setting. The most frequent diagnoses were supratentorial brain tumors, followed by patients with cerebrovascular diseases and infratentorial brain tumors. Three percent (30/879) of the patients originally assigned to floor or intermediate care status were transferred to the ICU. The most frequently observed neurological complications leading to ICU transfer were delayed postoperative neurological recovery, seizures, worsening of neurological deficits, hemiparesis, and cranial nerves deficits.

Conclusion

Our systematic review demonstrates that routine postoperative ICU admission may not benefit carefully selected patients who have undergone elective intracranial neurosurgical procedures. In addition, limiting routine ICU admission may result in significant cost savings.

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Author notes

  1. Cesar Cimonari de Almeida and M. Dustin Boone have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Lowry Medical Building 3B, 02215, Boston, MA, USA

    Cesar Cimonari de Almeida, Yosef Laviv & Ekkehard M. Kasper

  2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    M. Dustin Boone

  3. Department of Neurology, University of Erlangen, Erlangen, Germany

    Burkhard S. Kasper

  4. Department of Neurosurgery, University of California San Diego, San Diego, CA, USA

    Clark C. Chen

Authors
  1. Cesar Cimonari de Almeida
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  2. M. Dustin Boone
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  3. Yosef Laviv
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  4. Burkhard S. Kasper
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  5. Clark C. Chen
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Correspondence to M. Dustin Boone.

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de Almeida, C.C., Boone, M.D., Laviv, Y. et al. The Utility of Routine Intensive Care Admission for Patients Undergoing Intracranial Neurosurgical Procedures: A Systematic Review. Neurocrit Care 28, 35–42 (2018). https://doi.org/10.1007/s12028-017-0433-4

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