TY  - CONF
A1  - Qasem, Lina-Elisabeth
A1  - Al-Hilou, Ali
A1  - Zacharowski, Kai
A1  - Funke, Moritz
A1  - Strouhal, Ulrich
A1  - Jussen, Daniel Stephan
A1  - Konczalla, Jürgen
A1  - Forster, Marie-Thérèse
A1  - Prinz, Vincent Matthias
A1  - Lucia, Kristin
A1  - Czabanka, Marcus Alexander
T1  - Implementation of the "No ICU – Unless" approach in postoperative neurosurgical management in times of Covid-19
T2  - Brain and Spine
N2  - Background: Following elective craniotomy patients routinely receive monitoring on ICU. However, the benefit of ICU monitoring in these patients is discussed controversially. Due to the current COVID-19 pandemic, there are further limitations of ICU capacities. This study aimed to compare this strategy with a standardized management of post-craniotomy patients on ICU.
Methods: Two postoperative strategies were compared in a matched-pair analysis: The first cohort included patients treated between May-August 2021 according to the “No ICU – unless” concept (NIU group), where patients were managed on the normal ward postoperatively. The second cohort contained patients routinely admitted to the ICU between February-April 2021 (control group). Outcome parameters contained complications, length of stay, duration to first postoperative mobilization, number of unplanned imaging, number/type of ICU interventions and pre- and postoperative mRS. Patient characteristics were analyzed using electronic medical records.
Results: The NIU group consisted of 96 patients, the control group of 75 patients. Complication rates were comparable in both cohorts (16% in NIU vs. 17% in control; p=0.123). Groups did not differ significantly in the number of imaging (10% in NIU vs. 13% in control; p=0.67), in the type of interventions on ICU (antihypertensive therapy 5% (NIU) vs. 6% (control); p=0.825) or in the time to first postoperative mobilization (average 1.1± 1.6 days vs. 0.9± 1.2 days; p=0.402). Length of hospital stay was shorter in the NIU group without reaching statistical significance (average 5.8 vs. 6.8 days; p=0.481). There was no significant change in the distribution of preoperative (p=0.960) and postoperative (p=0.425) mRS scores.
Conclusion: Postoperative ICU management does not reduce postoperative complications and has no effect on the surgical outcome of elective craniotomies. The majority of postoperative complications are detected after a 24-hour observation period. This approach may represent a potential strategy to prevent overutilization of ICU capacities while maintaining sufficient postoperative care for neurosurgical patients.
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/78302
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-783020
SN  - 2772-5294
VL  - 2
IS  - Supplement 2, 101610
PB  - Elsevier
CY  - Amsterdam
ER  -