Reducing the burden of brain tumor surgery.

Craniotomy / adverse effects Humans Intensive Care Units Length of Stay Middle Aged Postoperative Complications / prevention & control Prospective Studies Supratentorial Neoplasms / surgery
Brain tumor Health care costs Neurosurgery Post-operative care

Journal

Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000

Informations de publication

Date de publication:
07 2021
Historique:
received: 29 05 2020
accepted: 16 08 2020
pubmed: 2 9 2020
medline: 21 10 2021
entrez: 2 9 2020
Statut: ppublish

Résumé

Even though the need has been challenged, admitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice. We have introduced a "no ICU, unless" policy for tumor craniotomy patients and evaluate costs, complications, and length of stay. A prospective cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 2 years after introduction of the new policy with the year before. A reduction in ICU/MCU admittance from 88 to 23% of patients was found resulting in 13% cost reduction. Also, the new policy resulted in a 1.4-day shorter post-operative length of stay. Minor complications were reduced, while major complications remained the same. All major complications are reviewed. We show that routine post-operative ICU/MCU admittance after tumor craniotomy does not reduce complications, but actually interferes with recovery of our patients. Changing the paradigm results in earlier discharge and cost reduction.

Sections du résumé

BACKGROUND
Even though the need has been challenged, admitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice. We have introduced a "no ICU, unless" policy for tumor craniotomy patients and evaluate costs, complications, and length of stay.
METHODS
A prospective cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 2 years after introduction of the new policy with the year before.
RESULTS
A reduction in ICU/MCU admittance from 88 to 23% of patients was found resulting in 13% cost reduction. Also, the new policy resulted in a 1.4-day shorter post-operative length of stay. Minor complications were reduced, while major complications remained the same. All major complications are reviewed.
CONCLUSIONS
We show that routine post-operative ICU/MCU admittance after tumor craniotomy does not reduce complications, but actually interferes with recovery of our patients. Changing the paradigm results in earlier discharge and cost reduction.

Identifiants

DOI: 10.1007/s00701-020-04543-y PMID: 32870422 PMC: PMC8195912
pubmed: 32870422
doi: 10.1007/s00701-020-04543-y
pii: 10.1007/s00701-020-04543-y
pmc: PMC8195912
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1879-1882

Références

Au K, Bharadwaj S, Venkatraghavan L, Bernstein M (2016) Outpatient brain tumor craniotomy under general anesthesia. J Neurosurg 125:1130–1135. https://doi.org/10.3171/2015.11.JNS152151
doi: 10.3171/2015.11.JNS152151 pubmed: 26943840
Beauregard CL, Friedman WA (2003) Routine use of postoperative ICU care for elective craniotomy: a cost-benefit analysis. Surg Neurol 60:483–489 dicussion 489
doi: 10.1016/S0090-3019(03)00517-2
Bui JQ, Mendis RL, van Gelder JM, Sheridan MM, Wright KM, Jaeger M (2011) Is postoperative intensive care unit admission a prerequisite for elective craniotomy? J Neurosurg 115:1236–1241. https://doi.org/10.3171/2011.8.JNS11105
doi: 10.3171/2011.8.JNS11105 pubmed: 21888476
de Almeida CC, Boone MD, Laviv Y, Kasper BS, Chen CC, Kasper EM (2018) The utility of routine intensive care admission for patients undergoing intracranial neurosurgical procedures: a systematic review. Neurocrit Care 28:35–42. https://doi.org/10.1007/s12028-017-0433-4
doi: 10.1007/s12028-017-0433-4 pubmed: 28808901
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
doi: 10.1097/01.sla.0000133083.54934.ae
Florman JE, Cushing D, Keller LA, Rughani AI (2017) A protocol for postoperative admission of elective craniotomy patients to a non-ICU or step-down setting. J Neurosurg 127:1392–1397. https://doi.org/10.3171/2016.10.JNS16954
doi: 10.3171/2016.10.JNS16954 pubmed: 28298034
Laan MT, Roelofs S, Van Huet I, Adang EMM, Bartels R (2020) Selective intensive care unit admission after adult supratentorial tumor craniotomy: complications, length of stay, and costs. Neurosurgery 86:E54–E59. https://doi.org/10.1093/neuros/nyz388
doi: 10.1093/neuros/nyz388 pubmed: 31541243
Mirza FA, Wang C, Pittman T (2017) Can patients safely be admitted to a ward after craniotomy for resection of intra-axial brain tumors? Br J Neurosurg 1–5. https://doi.org/10.1080/02688697.2017.1390064

Auteurs

Mark Ter Laan (M)

Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands. Mark.terlaan@radboudumc.nl.
ORCID: 0000-0002-9213-430X

Suzanne Roelofs (S)

Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands.

Eddy M M Adang (EMM)

Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.

Ronald H M A Bartels (RHMA)

Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.

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Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Craniotomie › Reducing the burden of brain tumor surgery.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Reducing the burden of brain tumor surgery.
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Reducing the burden of brain tumor surgery.
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Reducing the burden of brain tumor surgery.
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Reducing the burden of brain tumor surgery.
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Reducing the burden of brain tumor surgery.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Reducing the burden of brain tumor surgery.
questionsmedicales.fr › Maladies du système nerveux › Tumeurs du système nerveux › Tumeurs du système nerveux central › Tumeurs du cerveau › Tumeurs sus-tentorielles › Reducing the burden of brain tumor surgery.