Postoperative Surveillance in the Postoperative vs. Intensive Care Unit for Patients Undergoing Elective...

Background: Recent evidence suggests that alternative postoperative surveillance approaches for patients undergoing elective neurosurgical procedures are less resource-intensive and result in similar or fewer complications compared to high-care settings such as Intensive Care Units (ICUs). A new postoperative care protocol was established at our facility including routine PACU admission and predefined criteria for ICU admission. We aimed to demonstrate that PACU admission is a safe option for patients undergoing elective craniotomy following eventless surgery. Methods: This retrospective analysis included patients undergoing elective supratentorial craniotomy before and after the implementation of the new protocol. Patients with surgery between January 2020 and January 2022 and routine ICU admission were compared to patients undergoing surgery between February 2022 and March 2023 with either PACU or ICU admission based on the new protocol regarding lengths of hospital stay (LOSs), costs, and complications. Results: Data from a total of 405 patients, 198 patients before and 209 patients after the protocol implementation, were included. Both groups were comparable regarding demographics, American Society of Anesthesiologists (ASA) physical status classification, preexisting health conditions, and tumor entity and volume. Postoperative LOSs were significantly shorter in PACU compared to ICU patients of the same cohort (6 d vs. 11 d, p = 0.002). Patients with postoperative PACU transfer suffered fewer intracranial infections, surgical site infections, and pneumonia occurrences. Surgery-related complications, 30- and 90-day readmissions, and mortality rates were comparable in both groups. Conclusions: Postoperative PACU admission is a safe and viable option for patients undergoing elective craniotomy when selection is thorough and is associated with fewer ICU-related complications.