title: Postoperative intensive care unit requirements after elective craniotomy.
abstract: OBJECTIVE
  Commonly, patients undergoing craniotomy are admitted to an intensive care setting postoperatively to allow for close monitoring. We aim to determine the frequency with which patients who have undergone elective craniotomies require intensive care unit (ICU)-level interventions or experience significant complications during the postoperative period to identify a subset of patients for whom an alternative to ICU-level care may be appropriate.
  
  
  METHODS
  Following Institutional Review Board approval, a prospective, consecutive cohort of adult patients undergoing elective craniotomy was established at the Massachusetts General Hospital between the dates of April 2010 and March 2011. Inclusion criteria were intradural operations requiring craniotomy performed on adults (18 years of age or older). Exclusion criteria were cases of an urgent or emergent nature, patients who remained intubated postoperatively, and patients who had a ventriculostomy drain in place at the conclusion of the case.
  
  
  RESULTS
  Four hundred patients were analyzed. Univariate analysis revealed that patients with diabetes (P = 0.00047), those who required intraoperative blood product administration (P = 0.032), older patients (P < 0.0001), those with higher intraoperative blood losses (P = 0.041), and those who underwent longer surgical procedures (P = 0.021) were more likely to require ICU-level interventions or experience significant postoperative complications. Multivariate analysis only found diabetes (P = 0.0005) and age (P = 0.0091) to be predictive of a patient's need for postoperative ICU admission.
  
  
  CONCLUSIONS
  Diabetes and older age predict the need for ICU-level intervention after elective craniotomy. Properly selected patients may not require postcraniotomy ICU monitoring. Further study of resource utilization is necessary to validate these preliminary findings, particularly in different hospital types.
authors.affiliation: Department of Neurosurgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Hanak
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: walcott.brian@mgh.harvard.edu.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Walcott
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Brian V
authors.initials: BV
authors.lastname: Nahed
authors.affiliation: Biostatistics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Alona
authors.initials: A
authors.lastname: Muzikansky
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Mian
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Kimberly
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Curry
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003399:Craniotomy / Q000379:methods* / Q000401:mortality; D003422:Critical Care / Q000592:standards*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009529:Nicardipine / Q000627:therapeutic use; D010343:Patient Admission; D011182:Postoperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000628:therapy; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors
chemical_list: D002121:Calcium Channel Blockers; D009529:Nicardipine