title: Medical case management after laminectomy or craniotomy: do all patients benefit from admission to the intensive care unit?
abstract: To define severity of illness to identify most effectively patients for whom admission to the intensive care unit (ICU) is unnecessary, the authors performed a retrospective cost-effectiveness analysis. The authors studied the records of 113 patients who were admitted to the ICU after undergoing laminectomy (or other spinal cord surgery) or craniotomy for removal of neoplasm; the Acute Physiology and Chronic Health Evaluation III prognostic system had identified these patients as having a 10% or less risk of requiring intervention while in the ICU. No patient required active intervention during a mean stay of 3.26 days in the ICU. Combined use of a "step-down" postoperative care unit and ICU can optimize allocation of medical resources while providing high-quality care for some neurosurgical patients who are at low risk of requiring postoperative intervention.
authors.affiliation: Departments of Internal Medicine and Nursing, Kaiser Permanente Medical Center, Los Angeles, California.
authors.forename: J A
authors.initials: JA
authors.lastname: Nitahara
authors.forename: M
authors.initials: M
authors.lastname: Valencia
authors.forename: M A
authors.initials: MA
authors.lastname: Bronstein