Abstract
Routine intensive care unit monitoring is common after elective embolization of unruptured intracranial aneurysms. In this series of 200 consecutive endovascular procedures for unruptured intracranial aneurysms, 65% of patients were triaged to routine (non-intensive care unit) floor care based on intraoperative findings, aneurysm morphology, and absence of major co-morbidities. Only 1 patient (0.5%) required subsequent transfer to the intensive care unit for management of a perioperative complication. The authors conclude that patients without major co-morbidities, intraoperative complications, or complex aneurysm morphology can be safely observed in a regular ward rather than being admitted to the intensive care unit.
Highlights
We report the results of a policy of selective intensive care unit (ICU) admission after elective aneurysm treatment
After 69 (34.8%) of 200 procedures, patients were admitted to the ICU for the following reasons: intraoperative complications (n ϭ 16, 23%), investigational device (n ϭ 14, 20%), aneurysmal morphology (n ϭ 26, 38%), and medical co-morbidities (n ϭ 13, 19%)
Patients admitted to the ICU had larger aneurysms than those who went to the floor (12.6 Ϯ 9.2 mm versus 7.7 Ϯ 4.7 mm, P Ͻ .001)
Summary
Institutional review board approval was obtained for data collection. A prospective, consecutive series of patients treated for unruptured intracranial aneurysms by the senior author was created. Information collected included patient demographics, presentation, aneurysm size, location, treatment, admission (floor or ICU), change of care level, 24-hour complications, and 30-day follow-up. Institutional protocols regarding postsurgical care are listed in the On-line Appendix. Patient records were dichotomized to floor and ICU. Continuous independent variables, including age, aneurysm size, and length of stay, were compared with unpaired Student t tests. Independent categoric values, including anterior circulation and presentation (incidental, unrelated SAH, or symptomatic), were compared by means of 2 analysis
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