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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Implementation of the No ICU – unless concept in the postoperative care of patients after elective craniotomy

Einführung des No ICU – unless Konzepts in die Versorgung von Patienten nach elektiver Kraniotomie

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  • presenting/speaker Lina-Elisabeth Qasem - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland
  • presenting/speaker Ali Al-Hilou - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland
  • Kai Zacharowski - Universitätsklinikum Frankfurt, Anästhesiologie, Frankfurt a. M., Deutschland
  • Ulrich Strouhal - Universitätsklinikum Frankfurt, Anästhesiologie, Frankfurt a. M., Deutschland
  • Moritz Funke - Universitätsklinikum Frankfurt, Anästhesiologie, Frankfurt a. M., Deutschland
  • Daniel Jussen - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland
  • Jürgen Konczalla - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland
  • Marie-Thérèse Forster - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland
  • Vincent Prinz - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland
  • Kristin Elizabeth Lucia - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland
  • Marcus Czabanka - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV256

doi: 10.3205/22dgnc248, urn:nbn:de:0183-22dgnc2480

Published: May 25, 2022

© 2022 Qasem et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: In many neurosurgical departments, patients routinely receive 24-hour intensive care monitoring after elective craniotomy. However, there is no scientific evidence for the benefit of intensive medical monitoring in postoperative patients. Due to the current COVID-19 pandemic, there are further limitations in ICU capacities. The aim of this study was to evaluate the complication profile of a “No ICU – unless” strategy and a comparison to the standardized management of postoperative patients on the ICU.

Methods: Two postoperative policies were compared in two matched cohorts retrospectively: Cohort A with 96 patients who received treatment between May and August 2021 according to the No ICU - unless concept, where patients were managed on the normal ward. Control cohort B contained 75 patients who were routinely admitted to the ICU between February and April 2021. Detailed complication profile, length of hospital and ICU stay, duration to first postoperative mobilization, number of unplanned CTs/MRIs before planned postoperative imaging, number and type of intensive care interventions, and preoperative and postoperative mRS were collected from electronic medical records and compared.

Results: Complication rates were comparable in both cohorts (16% in cohort A vs. 17% in cohort B). The cohorts did not differ significantly in any of the evaluated parameters. The length of hospital stay was shorter in cohort A but did not reach statistical significance (Ø 5.8 vs. 6.8 days, p=0.481). The distribution of preoperative and postoperative mRS did not differ significantly.

Conclusion: Patients who were treated postoperatively on the normal care unit had a comparable complication rate to patients who were managed on the ICU. In addition, most complications occurred after the 24-hour observation period. The outcome of both cohorts was similar, with no significant difference in mRS at discharge.

Since both cohorts did not differ significantly, we conclude that the No ICU – unless concept is a potential and safe strategy to avoid ICU overutilization during the COVID-19 pandemic.