A Novel Protocol for Reducing Intensive Care Utilization After Craniotomyh

Background There is a growing body of evidence suggesting not all craniotomy patients require postoperative intensive care. Objective To devise and implement a standardized protocol for craniotomy patients eligible to transition directly from the operating room to the ward-the Non-Intensive CarE (NICE) protocol. Methods We preoperatively identified patients undergoing elective craniotomy for simple neurosurgical procedures with age Results From February 2018 to 2019, 63 patients were included in the NICE protocol with a median age of 46 yr and 65% female predominance. Of the operations performed, 38.1% were microvascular decompressions, 31.7% were craniotomy for tumor, 15.9% were cavernous malformation resections, and 14.3% were Chiari decompressions. No patients required transfer to the intensive care unit (ICU). Median length of stay was 2 d. There was an 11.1% overall readmission rate within the median follow-up period of 48 d. Three patients (4.8%) required reoperation at time of readmission within the follow-up period (1 postoperative subdural hematoma, 2 cerebrospinal fluid leak repair). None of these complications could have been identified with a postoperative ICU stay. Conclusion In our pilot trial of the NICE protocol, no patients required postoperative transfer to the ICU.