Clinical Characteristics and Outcomes of Neurosurgical Patients at a Level III Intensive Care Unit in Pakistan: A Retrospective Cohort Study.

Objective Neurosurgical patients account for the majority of cases across all surgical specialties that are admitted to the surgical intensive care unit (ICU) at our institution. The goal of this study was to analyze factors leading to ICU admission, type of neurosurgical intervention, length of ICU/hospital stays, and outcomes in terms of complications and ICU and in-hospital mortality. Methods This retrospective study conducted at the surgical ICU, Aga Khan University Hospital, investigated clinical data of neurosurgical patients admitted between January 2020 and June 2022. Quantitative data were collected regarding patients' characteristics, such as age, gender, comorbidities, type of surgical intervention, mode of surgery, source of admission to ICU, and type of osmotherapy. The primary and secondary outcomes were in terms of ICU and hospital mortality and complications. Results Among 321 patients admitted to the SICU, 197 were included according to inclusion/exclusion criteria. A total of 168 patients (85.3%) required surgical intervention, of whom 101 (60%) underwent elective surgery and 67 (40%) required emergency surgery. Thirteen patients died during the ICU or hospital stay, representing a mortality rate of 6.6%. The average length of stay in the ICU had a median IQR of 4 (4,6) days while the average hospital stay median IQR was 11 (12,18) days. Tracheostomy was performed in 77 patients (39%), and the median IQR day for tracheostomy was 4 (3,5) days. APACHE-II (Acute Physiology and Chronic Health Evaluation) score, length of ICU, and length of hospital stay were significantly higher in the deceased patients with a p-value of 0.042, 0.019, and 0.043, respectively. Conclusion In conclusion, this study on neurosurgical patients from the surgical intensive care unit of a low-middle-income country provided valuable insights about factors and their influence on outcomes. The study implies that a high APACHE-II score is linked to poorer outcomes for neurosurgical patients in this particular setting. Undertaking a large multicenter prospective study is vital for tailoring interventions and improving patient care in regions with limited resources where healthcare challenges may be distinct.

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The authors have declared that no competing interests exist.