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Related Experiment Video

Updated: Aug 14, 2025

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
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A Protocol for Reducing Intensive Care Utilization After Craniotomy: A 3-Year Assessment.

Gabriela D Ruiz Colón1, Rika Ohkuma2, Arjun V Pendharkar1

  • 1Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.

Neurosurgery
|January 14, 2023
PubMed
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The Non-Intensive CarE (NICE) protocol safely reduced intensive care unit (ICU) utilization for craniotomy patients, decreasing length of stay and costs without impacting outcomes. This approach enhances ICU bed availability and demonstrates effective patient selection for optimized care.

Area of Science:

  • Neurosurgery
  • Critical Care Medicine
  • Health Services Research

Background:

  • Traditionally, craniotomy patients require intensive care unit (ICU) postoperatively.
  • The Non-Intensive CarE (NICE) protocol was developed to identify suitable craniotomy patients for non-ICU care.
  • This protocol aims to optimize resource allocation and patient management pathways.

Purpose of the Study:

  • To evaluate the long-term effects of the NICE protocol.
  • Assessing the impact on postoperative length of stay (LOS), ICU utilization, readmissions, and complication rates.
  • Determining the protocol's efficacy in a real-world clinical setting.

Main Methods:

  • Retrospective cohort study analyzing electronic medical records.
  • Comparison of craniotomy patients before (May 2014-May 2018) and after (May 2018-December 2021) NICE protocol implementation.

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  • Primary endpoints: average postoperative LOS and ICU utilization; Secondary endpoints: readmissions, reoperation, and complication rates.

    • Main Results:

    • Overall postoperative LOS decreased from 4.0 to 3.5 days (P = .0031).
    • ICU utilization dropped from 57% to 42% (P < .0001), yielding significant cost savings.
    • Complications and return to ICU decreased post-protocol implementation.

    Conclusions:

    • The NICE protocol effectively reduces ICU utilization and costs without compromising patient outcomes.
    • This study represents the largest series of patients in an ICU utilization reduction protocol.
    • Careful patient selection is crucial for the successful implementation and sustainability of the NICE protocol.