ABSTRACT
OBJECTIVE Following elective craniotomy patients routinely receive 24-hour monitoring in an intensive care unit. However, the benefit of intensive care monitoring and treatment in these patients is discussed controversially. This study aimed to evaluate the complication profile of a “No ICU – unless” strategy and to compare this strategy with the standardized management of post-craniotomy patients in the ICU. METHODS Two postoperative management strategies were compared in a matched-pair analysis: The first cohort included patients who were managed on the normal ward postoperatively (“No ICU – unless” group). The second cohort contained patients routinely admitted to the ICU (control group). Outcome parameters contained detailed complication profile, length of hospital and ICU stay, duration to first postoperative mobilization, number of unplanned CTs/MRIs before planned postoperative imaging, number and type of intensive care interventions as well as pre- and postoperative modified Rankin Scale (mRS). Patient characteristics and clinical course were analyzed using electronic medical records. RESULTS The NIU group consisted of 96 patients and the control group consisted of 75 patients. Complication rates were comparable in both cohorts (16% in the NIU group vs. 17% in the control group; p = 0.123). Groups did not differ significantly in any of the outcome parameters examined. The length of hospital stay was shorter in the NIU group but did not reach statistical significance (average 5.8 vs. 6.8 days; p = 0.481). There was no significant change in the distribution of preoperative (p = 0.960) and postoperative (p = 0.425) mRS scores in the NIU and control group. CONCLUSION Routine postoperative ICU management does not reduce postoperative complications and does not affect the surgical outcome of patients after elective craniotomies. Most postoperative complications are detected after a 24-hour observation period. This approach may represent a potential strategy to prevent overutilization of ICU capacities while maintaining sufficient postoperative care for neurosurgical patients.