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Do Patients Still Require Admission to an Intensive Care Unit After Elective Craniotomy for Brain Surgery?

Rhondali, Ossam MD*; Genty, Céline BSc; Halle, Caroline MD*; Gardellin, Marianne MD*; Ollinet, Céline MD*; Oddoux, Manuela MD*; Carcey, Joëlle MD*; Francony, Gilles MD*; Fauvage, Bertrand MD*; Gay, Emmanuel MD, PhD; Bosson, Jean-Luc MD, PhD; Payen, Jean-François MD, PhD*

Journal of Neurosurgical Anesthesiology: April 2011 - Volume 23 - Issue 2 - p 118–123
doi: 10.1097/ANA.0b013e318206d5f8
Clinical Investigations

Background After elective craniotomy for brain surgery, patients are usually admitted to an intensive care unit (ICU). We sought to identify predictors of postoperative complications to define perioperative conditions that would safely allow ICU bypass.

Methods This observational cohort study enrolled 358 patients admitted to neuro-ICU after elective intracranial procedures. Postoperative complications were defined as unexpected events occurring within 24 hours of surgery that required imaging or treatment for neurologic deterioration.

Results Fifty-two patients were transferred postoperatively to neuro-ICU with sedation and mechanical ventilation. Of the remaining 306 patients subjected to an attempt to awake and extubate in the operating room, 26 (8%) developed 1 postoperative complication, primarily a new motor deficit, unexpected awakening delay, or subsequent deterioration in consciousness. Four intracerebral hematomas required surgical evacuation and each of these was detected within 2 hours after surgery. Predictors of postoperative complications included failure to extubate the trachea in operating room [odds ratio 61.8; 95% confidence interval (CI) 12.2-312.5], and, to a lesser extent, a duration of surgery of more than 4 hours (odds ratio 3.3; 95% CI 1.4-7.8), and lateral positioning of the patient during the procedure (odds ratio 2.8, 95% CI 1.2-6.4).

Conclusions Our results encourage prospectively testing the hypothesis that patients with immediate, successful tracheal extubation after elective craniotomy for brain surgery, with a surgical duration of less than 4 hours in a nonlateral position could be monitored safely in the postanesthesia care unit before being discharged to a neurosurgical ward.

Departments of *Anesthesia and Critical Care


Division of Biostatistics, Michallon Hospital, and Joseph Fourier University, Grenoble, France

All of the authors have disclosed that they have no financial relationship with or interest in any commercial companies.

Reprints: Jean-François Payen, MD, PhD, Pôle d'Anesthésie-Réanimation, Hôpital Albert Michallon, BP 217, F-38043 Grenoble, France (e-mail:

Received July 28, 2010

Accepted November 15, 2010

© 2011 Lippincott Williams & Wilkins, Inc.