Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany.
Departments of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany.
Neurosurg Rev. 2022 Oct;45(5):3437-3446. doi: 10.1007/s10143-022-01851-y. Epub 2022 Sep 8.
Following elective craniotomy, patients routinely receive 24-h monitoring in an intensive care unit (ICU). However, the benefit of intensive care monitoring and treatment in these patients is discussed controversially. This study aimed to evaluate the complication profile of a "No ICU - Unless" strategy and to compare this strategy with the standardized management of post-craniotomy patients in the ICU. Two postoperative management strategies were compared in a matched-pair analysis: The first cohort included patients who were managed in the normal ward postoperatively ("No ICU - Unless" group). The second cohort contained patients routinely admitted to the ICU (control group). Outcome parameters contained detailed complication profile, length of hospital and ICU stay, duration to first postoperative mobilization, number of unplanned imaging before scheduled postoperative imaging, number and type of intensive care interventions, as well as pre- and postoperative modified Rankin scale (mRS). Patient characteristics and clinical course were analyzed using electronic medical records. The No ICU - Unless (NIU) group consisted of 96 patients, and the control group consisted of 75 patients. Complication rates were comparable in both cohorts (16% in the NIU group vs. 17% in the control group; p = 0.123). Groups did not differ significantly in any of the outcome parameters examined. The length of hospital stay was shorter in the NIU group but did not reach statistical significance (average 5.8 vs. 6.8 days; p = 0.481). There was no significant change in the distribution of preoperative (p = 0.960) and postoperative (p = 0.425) mRS scores in the NIU and control groups. Routine postoperative ICU management does not reduce postoperative complications and does not affect the surgical outcome of patients after elective craniotomies. Most postoperative complications are detected after a 24-h observation period. This approach may represent a potential strategy to prevent the overutilization of ICU capacities while maintaining sufficient postoperative care for neurosurgical patients.
在择期开颅手术后，患者通常在重症监护病房（ICU）接受 24 小时监测。然而，关于这些患者的 ICU 监测和治疗的益处存在争议。本研究旨在评估“非 ICU-除非必要”策略的并发症情况，并将该策略与 ICU 中接受标准管理的术后患者进行比较。在配对分析中比较了两种术后管理策略：第一组包括术后在普通病房接受管理的患者（“非 ICU-除非必要”组）。第二组包括常规入住 ICU 的患者（对照组）。比较了两组患者的详细并发症情况、住院和 ICU 停留时间、首次术后活动时间、计划术后影像检查前的非计划影像检查次数、ICU 干预次数以及术前和术后改良 Rankin 量表（mRS）评分。使用电子病历分析患者特征和临床病程。非 ICU-除非必要（NIU）组包括 96 例患者，对照组包括 75 例患者。两组的并发症发生率相似（NIU 组为 16%，对照组为 17%；p=0.123）。在检查的所有结果参数中，两组均无显著差异。NIU 组的住院时间较短，但无统计学意义（平均 5.8 天 vs. 6.8 天；p=0.481）。NIU 组和对照组术前（p=0.960）和术后（p=0.425）mRS 评分的分布均无显著变化。常规术后 ICU 管理并不能降低术后并发症发生率，也不会影响择期开颅术后患者的手术结果。大多数术后并发症在 24 小时观察期后才被发现。这种方法可能是一种潜在的策略，可以防止 ICU 容量的过度利用，同时为神经外科患者提供足够的术后护理。
