gms | German Medical Science

Objective: Common practice in many hospitals requires for patients subject to open brain surgery a postoperative observation period on a dedicated intensive care unit (ICU). In some institutions this concept is challenged due to low complication rates and limited ICU resources. We were therefore interested in the evaluation of incidences retrospectively justifying a postoperative observation period on an ICU.

Methods: We retrospectively analysed the postoperative courses of 448 patients subject to elective resection of a glioma (February 2004–January 2009). Critical incidences (CIs) were defined as occurrences, requiring additional medical attendance. CIs were identified by using the documentation software (CareVue^®) implemented on our ICU or by clinical notes.

Results: 417 patients were immediately transferred from surgery to the ICU, 31 patients were directly transferred to normal care (93,1%/ 6,9%). 17 CIs were identified (3,79%, 16 ICU/1 normal care). CIs were distributed as follows: generalized seizure (n=7), focal seizure (n=2), rebleeding (n=3), reintubation (n=2), brain oedema with herniation (n=1), chest tube after central line (n=1), acute coronary syndrome (n=1). Postoperative hypertension defined as minor [syst. 140–159 mmHG] was detected in 74 and defined as severe [syst. ≥160 mmHG] in 42 patients. A high dosed antihypertensive therapy (in excess of 50mg Ebrantil/h) was required in 29 patients. Median holding time on the ICU in the years 2004–2008 were 0.92 d, 0.805 d, 0.79 d, 0.75 d and 0.525 d, respectively.

Conclusions: The small number of serious CIs challenges the concept of a compulsory postoperative observation period on an ICU for glioma patients, subject to elective brain surgery. This notion is also reflected in the decreasing holding time on the ICU. In all observed CIs an intermediate care unit (IMCU) would have been sufficient to diagnose and treat the CIs. However, if no IMCU is available, a direct transfer to normal care is not recommendable.