gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

The necessity of postoperative surveillance on an ICU after elective Glioma-Surgery: a retrospective analysis of 448 patients

Meeting Abstract

  • Juliane Schroeteler - Neurochirurgische Klinik, Heinrich Heine Universität Düsseldorf, Deutschland
  • M.-D. Dings - Neurochirurgische Klinik, Heinrich Heine Universität Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Neurochirurgische Klinik, Heinrich Heine Universität Düsseldorf, Deutschland
  • M. Weiss - Klinik für Anästhesiologie der Medizinischen Einrichtungen der Heinrich Heine Universität Düsseldorf, Deutschland
  • Michael Sabel - Neurochirurgische Klinik, Heinrich Heine Universität Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1563

DOI: 10.3205/10dgnc039, URN: urn:nbn:de:0183-10dgnc0394

Published: September 16, 2010

© 2010 Schroeteler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Common practice in many hospitals requires for patients subject to open brain surgery a postoperative observation period on a dedicated intensive care unit (ICU). In some institutions this concept is challenged due to low complication rates and limited ICU resources. We were therefore interested in the evaluation of incidences retrospectively justifying a postoperative observation period on an ICU.

Methods: We retrospectively analysed the postoperative courses of 448 patients subject to elective resection of a glioma (February 2004–January 2009). Critical incidences (CIs) were defined as occurrences, requiring additional medical attendance. CIs were identified by using the documentation software (CareVue®) implemented on our ICU or by clinical notes.

Results: 417 patients were immediately transferred from surgery to the ICU, 31 patients were directly transferred to normal care (93,1%/ 6,9%). 17 CIs were identified (3,79%, 16 ICU/1 normal care). CIs were distributed as follows: generalized seizure (n=7), focal seizure (n=2), rebleeding (n=3), reintubation (n=2), brain oedema with herniation (n=1), chest tube after central line (n=1), acute coronary syndrome (n=1). Postoperative hypertension defined as minor [syst. 140–159 mmHG] was detected in 74 and defined as severe [syst. ≥160 mmHG] in 42 patients. A high dosed antihypertensive therapy (in excess of 50mg Ebrantil/h) was required in 29 patients. Median holding time on the ICU in the years 2004–2008 were 0.92 d, 0.805 d, 0.79 d, 0.75 d and 0.525 d, respectively.

Conclusions: The small number of serious CIs challenges the concept of a compulsory postoperative observation period on an ICU for glioma patients, subject to elective brain surgery. This notion is also reflected in the decreasing holding time on the ICU. In all observed CIs an intermediate care unit (IMCU) would have been sufficient to diagnose and treat the CIs. However, if no IMCU is available, a direct transfer to normal care is not recommendable.