Neurosurgery resident Tej Azad recaps his presentation from the 2022 Congress of Neurological Surgeons annual meeting, during which he identified a lesson learned from the COVID-19 pandemic. A review of 27 studies showed there is an opportunity to conserve intensive care unit (ICU) resources by carefully selecting candidates for elective craniotomy for non-ICU settings. Further study is needed to standardize patient selection and postoperative care paradigms before this can be translated on a larger scale.
My name is Ted Azad. I'm A P G Y for neurosurgery resident here at johns Hopkins and I wanted to discuss a little bit of work that we presented recently at the CNS, the Congress of neurological surgeons in san Francisco. The COVID-19 pandemic has taught us countless lessons. One key learning point has been that our ability to care for critically ill patients is finite. I see you capabilities must be considered a scarce resource comprised of both material and more importantly, human capital and resources. In this vein, researchers have started to investigate if elective craniotomy is one of the most common neuro surgeries performed at johNS Hopkins may be candidates for non ICU level of care following surgery. This is certainly a break from precedent. Classically any cranial surgery as standard of care would require an ICU level of care. If not a dedicated neuro ICU. As surgical techniques and peri operative care have improved. However, the possibility of identifying subgroups of elective craniotomy patients who may be candidates for non ICU care has emerged to study this. We designed a systematic review to evaluate and integrate the single series studies that have investigated non ICU care following elective craniotomy. We found 27 studies over two decades that investigated this concept consistently hospital length of stay and overall costs were lower in non ICU post craniotomy patients of nearly 2500 patients in these non ICU post craniotomy settings, just 2% required transitions to a higher level of care. Patient selection is truly key here. Some common preoperative selection factors were an age less than 65 years, super territorially located lesions and smaller tumors taken together. This body of evidence suggests that non ICU care pathways for carefully selected post craniotomy patients may represent a meaningful opportunity to conserve ICU resources and limit costs. Without sacrificing patient safety, However, it must be kept in mind that the standardization of patient selection and postoperative care paradigms is necessary before these efforts can be meaningfully deployed at any kind of scale. Future multi center studies and registries are needed to realize generalized protocols and to enable the development of intelligent patient selection algorithms.