title: Utility of the intensive care unit in patients undergoing microvascular decompression: a multiinstitution comparative analysis.
abstract: OBJECTIVE Use of the ICU during admission to a hospital is associated with a significant portion of the total health care costs for that stay. Patients undergoing microvascular decompression (MVD) for cranial neuralgias are routinely admitted postoperatively to the ICU for monitoring. The primary purpose of this study was to compare complication rates of patients with and without a postoperative ICU stay following MVD. The secondary intents were to identify predictors of complications, to analyze variables of health care resource utilization, and to estimate the cost of postoperative management. METHODS The authors performed a retrospective comparative analysis of consecutive patients undergoing MVD at 2 institutions. A total of 199 patients without a postoperative ICU stay from Institution A and 119 patients with an ICU stay from Institution B were reviewed. Inclusion criteria included any adult (i.e., 18 years of age or older) undergoing MVD for trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, or geniculate neuralgia. Patients with incomplete medical records were excluded. Medical comorbidities, intraoperative variables, complications, postoperative interventions, and variables indicating health care resource utilization were reviewed. RESULTS The study compared 190 patients without a postoperative ICU stay from Institution A with 90 patients with an ICU stay from Institution B. Seven patients without an ICU stay and 5 patients with an ICU stay experienced complications after surgery (p = 0.53). Multivariate analysis identified coronary artery disease to be a predictor of complications (p = 0.037, OR 6.23, 95% CI 1.12-34.63). Patients from Institution A without a postoperative ICU stay had a significantly shorter length of stay, by approximately 16 hours (p < 0.001), and received less postoperative imaging (p < 0.001, OR 14.39, 95% CI 7.75-26.74) and postoperative diagnostic testing (p < 0.001) than patients from Institution B with an ICU stay. Estimated cost savings in patients without an ICU stay and 1 less day of inpatient recovery was calculated as $1400 per patient. CONCLUSIONS Selective versus routine use of ICU care as well as postoperative imaging and diagnostic testing may be safe after MVD and can lead to a reduction in overall health care costs.
authors: University of Pittsburgh School of Medicine and.
authors: Jesse D
authors: JD
authors: Lawrence
authors: Indiana University School of Medicine.
authors: Chad
authors: C
authors: Tuchek
authors: Department of Neurological Surgery, Indiana University.|Goodman Campbell Brain and Spine; and.|Simon Cancer Center, Indiana University, Indianapolis, Indiana.
authors: Aaron A
authors: AA
authors: Cohen-Gadol
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Raymond F
authors: RF
authors: Sekula
mesh_terms: D000293:Adolescent; D000328:Adult; D003399:Craniotomy; D019569:Hemifacial Spasm / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D061145:Microvascular Decompression Surgery; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: CBC = complete blood count; HFS = hemifacial spasm; HR = heart rate; IV = intravenous; LOS = length of stay; MVD = microvascular decompression; PACU = postanesthesia care unit; RR = respiratory rate; SBP = systolic blood pressure; TN = trigeminal neuralgia; UTI = urinary tract infection; cost; intensive care unit; microvascular decompression; skull base; value