Reducing the burden of brain tumor surgery

Mark Ter Laan,Suzanne Roelofs,Eddy M M Adang,Ronald H M A Bartels

doi:10.1007/s00701-020-04543-y

Mark Ter Laan, Suzanne Roelofs + Show 2 more

Open Access

https://doi.org/10.1007/s00701-020-04543-y

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Abstract

BackgroundEven 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.MethodsA 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.ResultsA 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.ConclusionsWe 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.

Highlights

The need for post-operative admittance to medium or intensive care units after craniotomy was challenged [1,2,3,4, 6,7,8]
The main reason for changing the post-operative regimen was the fact that patients on average reported quick recovery after tumor craniotomy, but complained about the burden of the stay at the ICU post-operatively
After introduction of a “no-ICU-unless” protocol for our craniotomy patients we previously reported short-term results and found satisfied patients, comparable complication rates, and significant reduction of costs [7]

Summary

Introduction

The need for post-operative admittance to medium or intensive care units after craniotomy was challenged [1,2,3,4, 6,7,8]. After introduction of a “no-ICU-unless” protocol for our craniotomy patients we previously reported short-term results and found satisfied patients, comparable complication rates, and significant reduction of costs [7]. In this new report we present the results 2 years after introduction of this protocol was implemented. 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.

Methods

Results

Conclusion