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Updated: Nov 3, 2025

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A Novel Protocol for Reducing Intensive Care Utilization After Craniotomy.

Arjun V Pendharkar1, Maryam N Shahin1, Sohun S Awsare1

  • 1Department of Neurosurgery, Stanford University, Stanford, California, USA.

Neurosurgery
|June 5, 2021
PubMed
Summary
This summary is machine-generated.

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The Non-Intensive CarE (NICE) protocol successfully allowed selected craniotomy patients to bypass the intensive care unit (ICU). This pilot study found no patients required ICU transfer, demonstrating a safe alternative for postoperative care.

Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Patient Care Management

Background:

  • Evidence suggests not all craniotomy patients necessitate intensive care unit (ICU) admission post-surgery.
  • Developing standardized protocols can optimize postoperative care pathways.

Purpose of the Study:

  • To implement and evaluate the Non-Intensive CarE (NICE) protocol for direct ward transfer of select craniotomy patients.
  • To assess the safety and efficacy of the NICE protocol in a pilot trial.

Main Methods:

  • Elective craniotomy patients under 65 with ASA class 1-3 were preoperatively identified.
  • Postoperative eligibility was confirmed by surgical and anesthesia teams.
  • Patients received hourly neurological checks by neuroscience nurses for the first 8 hours on the ward.
Keywords:
CostCraniotomyIntensive care unitOutcomeQuality

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Main Results:

  • 63 patients were enrolled in the NICE protocol; none required ICU transfer.
  • Median length of stay was 2 days, with an 11.1% readmission rate.
  • Complications included subdural hematoma and cerebrospinal fluid leaks, none preventable by ICU stay.

Conclusions:

  • The NICE protocol is a safe and effective strategy for managing select craniotomy patients without ICU admission.
  • This approach can streamline postoperative care and potentially reduce healthcare resource utilization.