Routine use of postoperative ICU care for elective craniotomy: a cost-benefit analysis

Postoperative monitoring in an intensive care unit (ICU) setting following elective craniotomy is routine at many institutions, as it is believed that this reduces the incidence and potential seriousness of early postoperative complications. This is unproven, however, and ICU resources are scarce and costly. At our institution, one surgeon began to routinely transfer elective craniotomy patients directly to the floor following an uneventful postanesthesia care unit (PACU) recovery. This study was undertaken to see whether that practice was safe and cost-effective.

A retrospective cohort of 430 consecutive, elective adult craniotomies, from February, 2000 to September, 2001 were analyzed. Variables were divided into 12 major groups: attending surgeon, age, sex, diagnosis, Current Procedural Terminology (CPT) code, length of stay, preoperative deficit, medical co-morbidities, postop floor, medical complications, neurological complications, and total hospitalization cost.

Patients admitted to the surgical intensive care unit (SICU) did not have fewer complications than patients transferred directly to the floor. Patients admitted to the SICU did not have more preoperative neurological deficits or medical co-morbidities. Age was not a significant predictor of either medical or neurological complications. In patients without initial postop complications, only length of stay and postop floor assignment correlated with cost (p < 0.001). Immediate transfer to the floor decreased average hospitalization length by 3 days, and provided cost savings of $4,026 per patient.

Selective, rather than routine use of postoperative ICU care in elective craniotomy patients is safe, resulting in no greater incidence of medical or neurological complications, and may provide significant reductions in average hospitalization length and cost.