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Neurocritical Care

, Volume 28, Issue 1, pp 35–42 | Cite as

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

  • Cesar Cimonari de Almeida
  • M. Dustin BooneEmail author
  • Yosef Laviv
  • Burkhard S. Kasper
  • Clark C. Chen
  • Ekkehard M. Kasper
Original Article

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.

Keywords

Craniotomy Neurosurgical procedures Intensive care Postoperative complications Resource allocation Healthcare quality 

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Cesar Cimonari de Almeida
    • 1
  • M. Dustin Boone
    • 2
    Email author
  • Yosef Laviv
    • 1
  • Burkhard S. Kasper
    • 3
  • Clark C. Chen
    • 4
  • Ekkehard M. Kasper
    • 1
  1. 1.Department of Surgery, Division of NeurosurgeryBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Department of Anesthesia, Critical Care and Pain MedicineBeth Israel Deaconess Medical CenterBostonUSA
  3. 3.Department of NeurologyUniversity of ErlangenErlangenGermany
  4. 4.Department of NeurosurgeryUniversity of California San DiegoSan DiegoUSA

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