Background and Goal of Study: After surgery, patients are usually admitted to an intermediate care unit (IMCU) or an intensive care unit (ICU), more often for 24 h. However, in our centre, shortage in intensive care beds has led to a policy of direct transfer to neurosurgical ward, if possible. This study investigates the safety of this approach.

Materials and Methods: Between April 2016 and July 2017, 306 consecutive adult patients undergoing elective craniotomy in our centre were included. Immediately after surgery, the anesthesiologist chose whether to attempt to awake or whether to carry on sedation: if sedation was to be prolonged, the patients were transferred to an ICU; otherwise, they were transferred to a Post-Anesthesia Care Unit (PACU), still
being intubated. The extubation was attempted, according to their recovery and neurological status and they were followed for at least 4 h before being discharged. They were followed up for 24 h after surgery to determine the incidence of major early postoperative complications, their time to occurrence and their management. Potential predictive factors for these complications were investigated. 

Results and Discussion: At the end of surgery, 5 patients were directly admitted in ICU. Among the 301 patients directly admitted to the post-anesthesia care unit (PACU), 50 patients (16%) presented a severe complication in the first 24 h after surgery. Neurological complications were the most frequent. The median time to occurrence was 2 h and 80% of complications occurred in PACU: 33 patients needed unplanned admission in IMCU or ICU. Among the 256 patients directly transferred to neurosurgical ward, 7 (2.7%) developed a complication and only 2 (0.8%) had to be transferred to IMCU or ICU. The factors identified as predictive of complications were: the absence of known hypertension, intensive care within the past year,
temporal lobe surgery, prolonged surgery and anesthesia, extensive peroperative blood loss, substantial volume expansion, blood transfusion, and delayed extubation.

Conclusion(s): The low incidence of major complications occurring in neurosurgical ward indicates that a large majority of patients can safely be admitted directly to neurosurgical ward after elective craniotomy.

09 / After Elective Craniotomy, what proportion of patients can safely bypass ICU admission?