Artikel
Is there a need for routinely intensive care unit admission after elective craniotomy for epilepsy surgery? Time to re-think the paradigm
Ist eine intensiv-medizinische Überwachung nach einer elektiven Kraniotomie im Rahmen eines epilepsiechirurgischen Eingriffs notwendig? Zeit für einen Paradigmenwechsel
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Autoren
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Majd Bahna
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Motaz Hamed
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Inja Ilic
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Abdallah Salemdawod
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Matthias Schneider
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Lars Eichhorn
- Universitätsklinikum Bonn, Department of Anaesthesiology and Intensive Care, Bonn, Deutschland
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Felix Lehmann
- Universitätsklinikum Bonn, Department of Anaesthesiology and Intensive Care, Bonn, Deutschland
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Christian Bode
- Universitätsklinikum Bonn, Department of Anaesthesiology and Intensive Care, Bonn, Deutschland
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Patrick Schuss
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Erdem Güresir
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Rainer Surges
- Universitätsklinikum Bonn, Klinik für Epileptologie, Bonn, Deutschland
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Hartmut Vatter
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Valeri Borger
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Traditionally, patients undergoing elective craniotomy for epilepsy surgery are monitored postoperative in an intensive care unit (ICU) overnight in order to quickly recognize a potential postoperative complication. In this study, the authors investigated the frequency postoperative events required ICU setting in patients who had undergone elective craniotomy for epilepsy surgery. Furthermore, we aimed to evaluate whether routine postoperative admission to a step-down unit is safe in this patient population.
Methods: A cohort study was performed assessing patients with medically intractable epilepsy who underwent elective craniotomy for epilepsy surgery between 2012 and 2019 at the authors’ institution (n=273). The recorded data included age, relevant accompanying conditions, type of surgical approach, intraoperative surgical and anesthesiological events as well as adverse events requiring ICU settings. A multivariate analysis was performed to identify independent pre- and intraoperative risk factors for postoperative adverse events requiring ICU care.
Results: Overall, 256 out of 273 patients (93.8%) who underwent elective craniotomy for epilepsy surgery required no ICU setting or intervention during the postoperative course. The univariate analysis revealed that patients with planned functional hemispherectomy (p < 0.0005), ASA-Score ≥ 3 (p=0.027), diabetes mellitus (p=0.047), BMI ≥ 30 (p=0.02), intraoperative surgical abnormalities and tissue vulnerability (p=0.032), prolonged surgery length (p=0,025), and intraoperative blood loss > 325ml (p<0.0005) were more likely to develop an adverse event, which necessitated an ICU intervention. The multivariate analysis only found planned functional hemispherectomy (OR=33; p<0.0005), intraoperative blood loss > 325ml (OR=4.7; p=0.012), intraoperative surgical abnormalities and tissue vulnerability (OR=4.2; p=0.047) and diabetes mellitus (OR=9.33; p=0.025) as independent predictors for postoperative ICU admission.
Conclusion: Our results show that routinely step-down ward admission for patients undergoing elective craniotomy might be feasible and safe. However, attention should be paid to patients with planned functional hemispherotomy, increased intraoperative blood loss (>325ml) and diabetes mellitus, who should be monitored postoperatively on ICU.
