When Is ICU Admission Required for Postoperative Neurosurgical Patients?

Abstract

Admission to ICU is standard following neurosurgical procedures, however several studies have shown that postoperative neurosurgical patients require only neurological monitoring with minimal ICU interventions. This study evaluates if a subgroup of patients can be identified and safely cared for in an intermediate care unit. It is a retrospective analysis of neurosurgical admissions to the SICU in a metropolitan teaching hospital over a period of 3 years. High-intensity (HI) patients were defined as those requiring active ICU therapy and interventions. Low-intensity (LI) patients were considered potential intermediate care unit candidates. From 1730 neurosurgical SICU admissions, there were 407 HI patients (26%). The remaining LI patients received 3039 days of SICU care, including 2186 days (72%) with a Glasgow Coma Scale >14. In the LI group, 76.5% of patients had a length of stay of 24 hours or less. The average daily neurosurgical census comprised 2.8 LI and 2.9 HI patients/day. Approximately 75% of neurosurgical SICU admissions meet LI criteria. They have lower admission severity scores and usually stay in the SICU for 1 day or less. The authors conclude that an average of 2.8 LI patients currently receiving care in the SICU each day could be safely cared for in an intermediate care unit.