ArticleNeurosurgical review2022
Implementation of the "No ICU - Unless" approach in postoperative neurosurgical management in times of COVID-19.
Article in Neurosurgical review, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- A cost-sensitive multiclass machine learning framework for postoperative neurosurgical triage (Neuro-TACTIC).Scientific reports · 2026Article
- Single-stage versus two-stage resection for large anterior midline skull base meningiomas with bihemispheric peritumoral edema.Scientific reports · 2025Article
- No ICU Unless 2.0 - Refining ICU admission criteria after elective craniotomy.Brain & spine · 2025Article
- Routine ICU Surveillance after Brain Tumor Surgery: Patient Selection Using Machine Learning.Journal of clinical medicine · 2024Article
- Routine ICU admission after brain tumor surgery: retrospective validation and critical appraisal of two prediction scores.Acta neurochirurgica · 2023Article
- Unplanned intensive care unit readmission after surgical treatment in patients with newly diagnosed glioblastoma - forfeiture of surgically achieved advantages?Neurosurgical review · 2023Article
- Repetitive Electroencephalography as Biomarker for the Prediction of Survival in Patients with Post-Hypoxic Encephalopathy.Journal of clinical medicine · 2022Article
- Perioperative outcomes in patients with symptomatic versus asymptomatic previous COVID-19 infection undergoing neurosurgical treatment (post-COVID-19 study).Journal of anaesthesiology, clinical pharmacologyArticle
- Evaluation of risk factors for postoperative neurologic intensive care admission after brain tumor craniotomy: A single-center longitudinal study.Journal of anaesthesiology, clinical pharmacologyArticle
Corrections and comments
- Erratum issued
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Following elective craniotomy, patients routinely receive 24-h monitoring in an intensive care unit (ICU). 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. Two postoperative management strategies were compared in a matched-pair analysis: The first cohort included patients who were managed in 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 imaging before scheduled 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. The No ICU - Unless (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 groups. 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-h observation period. This approach may represent a potential strategy to prevent the overutilization of ICU capacities while maintaining sufficient postoperative care for neurosurgical patients.
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