National survey on postoperative care and treatment circuits in neurosurgery.
BACKGROUND
The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country.


METHODS
From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR.


RESULTS
We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%.


CONCLUSIONS
There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period.
Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España. Electronic address: rvalero@clinic.cat.
R
R
Valero
Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
E
E
Carrero
Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
N
N
Fàbregas
Servicio de Anestesiología, Hospital Universitario Cruces, Bilbao, Vizcaya, España.
F
F
Iturri
Servicio de Anestesiología, Hospital 9 de Octubre, Valencia, España.
N
N
Saiz-Sapena
Servicio de Anestesiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España.
L
L
Valencia
D000700:Analgesics / Q000627:therapeutic use; D000776:Anesthesiology / Q000379:methods; D000927:Anticonvulsants / Q000627:therapeutic use; D019468:Disease Management; D004363:Drug Utilization; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D059408:Pain Management / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000628:therapy; D013030:Spain
D000700:Analgesics; D000927:Anticonvulsants
Circuitos de atención postoperatoria; Encuesta nacional; National survey; Neurocirugía; Neurosurgery; Postoperative circuits; Postoperative treatment; Tratamiento postoperatorio