title: Do patients still require admission to an intensive care unit after elective craniotomy for brain surgery?
abstract: BACKGROUND
  After elective craniotomy for brain surgery, patients are usually admitted to an intensive care unit (ICU). We sought to identify predictors of postoperative complications to define perioperative conditions that would safely allow ICU bypass.
  
  
  METHODS
  This observational cohort study enrolled 358 patients admitted to neuro-ICU after elective intracranial procedures. Postoperative complications were defined as unexpected events occurring within 24 hours of surgery that required imaging or treatment for neurologic deterioration.
  
  
  RESULTS
  Fifty-two patients were transferred postoperatively to neuro-ICU with sedation and mechanical ventilation. Of the remaining 306 patients subjected to an attempt to awake and extubate in the operating room, 26 (8%) developed 1 postoperative complication, primarily a new motor deficit, unexpected awakening delay, or subsequent deterioration in consciousness. Four intracerebral hematomas required surgical evacuation and each of these was detected within 2 hours after surgery. Predictors of postoperative complications included failure to extubate the trachea in operating room [odds ratio 61.8; 95% confidence interval (CI) 12.2-312.5], and, to a lesser extent, a duration of surgery of more than 4 hours (odds ratio 3.3; 95% CI 1.4-7.8), and lateral positioning of the patient during the procedure (odds ratio 2.8, 95% CI 1.2-6.4).
  
  
  CONCLUSIONS
  Our results encourage prospectively testing the hypothesis that patients with immediate, successful tracheal extubation after elective craniotomy for brain surgery, with a surgical duration of less than 4 hours in a nonlateral position could be monitored safely in the postanesthesia care unit before being discharged to a neurosurgical ward.
authors.affiliation: Department of Anesthesia and Critical Care, Michallon Hospital, and Joseph Fourier University, Grenoble, France.
authors.forename: Ossam
authors.initials: O
authors.lastname: Rhondali
authors.forename: Céline
authors.initials: C
authors.lastname: Genty
authors.forename: Caroline
authors.initials: C
authors.lastname: Halle
authors.forename: Marianne
authors.initials: M
authors.lastname: Gardellin
authors.forename: Céline
authors.initials: C
authors.lastname: Ollinet
authors.forename: Manuela
authors.initials: M
authors.lastname: Oddoux
authors.forename: Joëlle
authors.initials: J
authors.lastname: Carcey
authors.forename: Gilles
authors.initials: G
authors.lastname: Francony
authors.forename: Bertrand
authors.initials: B
authors.lastname: Fauvage
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gay
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bosson
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Payen
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D001803:Blood Transfusion; D001921:Brain / Q000601:surgery*; D015331:Cohort Studies; D003399:Craniotomy; D003422:Critical Care; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D016017:Odds Ratio; D010952:Plasma Substitutes / Q000627:therapeutic use; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011187:Posture; D011787:Quality of Health Care; D012307:Risk Factors; D012449:Safety
chemical_list: D010952:Plasma Substitutes