A protocol for postoperative admission of elective craniotomy patients to a non-ICU or step-down setting.
Document Type
Article
Publication Date
12-1-2017
Institution/Department
Neurology; Surgery
Journal Title
Journal of neurosurgery.
Abstract
OBJECTIVE Selecting the appropriate patients undergoing craniotomy who can safely forgo postoperative intensive care unit (ICU) monitoring remains a source of debate. Through a multidisciplinary work group, the authors redefined their institutional care process for postoperative monitoring of patients undergoing elective craniotomy to include transfer from the postanesthesia care unit (PACU) to the neurosurgical floor. The hypothesis was that an appropriately selected group of patients undergoing craniotomy could be safely managed outside the ICU in the postoperative period. METHODS The work group developed and implemented a protocol for transfer of patients to the neurosurgical floor after 4-hour recovery in the PACU following elective craniotomy for supratentorial tumor. Criteria included hemodynamically stable adults without significant new postoperative neurological impairment. Data were prospectively collected including patient demographics, clinical characteristics, surgical details, postoperative complications, and events surrounding transfer to a higher level of care. RESULTS Of the first 200 consecutive patients admitted to the floor, 5 underwent escalation of care in the first 48 hours. Three of these escalations were for agitation, 1 for seizure, and 1 for neurological change. Ninety-eight percent of patients meeting criteria for transfer to the floor were managed without incident. No patient experienced a major complication or any permanent morbidity or mortality following this care pathway. CONCLUSIONS Care of patients undergoing uneventful elective supratentorial craniotomy for tumor on a neurosurgical floor after 4 hours of PACU monitoring appears to be a safe practice in this patient population. This tailored practice safely optimized hospital resources, is financially responsible, and is a strong tool for improving health care value.
ISSN
1933-0693
First Page
1392
Last Page
1397
Recommended Citation
Florman, Jeffrey E; Cushing, Deborah; Keller, Lynne A; and Rughani, Anand I, "A protocol for postoperative admission of elective craniotomy patients to a non-ICU or step-down setting." (2017). MaineHealth Maine Medical Center. 627.
https://knowledgeconnection.mainehealth.org/mmc/627