Reducing the burden of brain tumor surgery
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ORIGINAL ARTICLE - TUMOR - OTHER
Reducing the burden of brain tumor surgery Mark ter Laan 1
&
Suzanne Roelofs 2 & Eddy M. M. Adang 3 & Ronald H. M. A. Bartels 1
Received: 29 May 2020 / Accepted: 16 August 2020 # The Author(s) 2020
Abstract Background Even though the need has been challenged, admitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice. We have introduced a “no ICU, unless” policy for tumor craniotomy patients and evaluate costs, complications, and length of stay. Methods A prospective cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 2 years after introduction of the new policy with the year before. Results A reduction in ICU/MCU admittance from 88 to 23% of patients was found resulting in 13% cost reduction. Also, the new policy resulted in a 1.4-day shorter post-operative length of stay. Minor complications were reduced, while major complications remained the same. All major complications are reviewed. Conclusions We show that routine post-operative ICU/MCU admittance after tumor craniotomy does not reduce complications, but actually interferes with recovery of our patients. Changing the paradigm results in earlier discharge and cost reduction. Keywords Brain tumor . Neurosurgery . Health care costs . Post-operative care
Introduction Previously, the need for post-operative admittance to medium or intensive care units after craniotomy was challenged [1–4, 6–8]. The main reason for changing the post-operative regimen was the fact that patients on average reported quick recovery after tumor craniotomy, but complained about the burden of the stay at the ICU post-operatively. A retrospective analysis of our own complications showed a very low incidence, and therefore, we questioned the need for intensive post-operative monitoring. Also, a change in regimen could This article is part of the Topical Collection on Tumor - other Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04543-y) contains supplementary material, which is available to authorized users. * Mark ter Laan [email protected] 1
Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
2
Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
3
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
possibly reduce the burden on ICU planning (which has led to postponing surgery) and increase cost efficiency. After introduction of a “no-ICU-unless” protocol for our craniotomy patients we previously reported short-term results and found satisfied patients, comparable complication rates, and significant reduction of costs [7]. In this new report we present the results 2 years after introduction of this protocol was implemented. This allows for inclusion of more than twice the number of patients and detecting more significant differe
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