Safety and Feasibility of a Fast-Track Pathway for Neurosurgical Craniotomy Patients: Bypassing the Intensive Care Unit

Carlos Perez-Vega MD , Devang K. Sanghavi MBBS, MD , Pablo Moreno Franco MD , Ryan M. Chadha MD , Alberto E. Ardon MD , Elird Bojaxhi MD , Klaus D. Torp MD , Lisa A. Marshall RN , Tiffany M. Halstead RN , Valentino E. Ford RN , Lynda M. Christel , Sanjeet S. Grewal MD , Kaisorn L. Chaichana MD , Alfredo Quinones-Hinojosa MD , Levi W. Howard DO , W. Christopher Fox MD , William D. Freeman MD , NPCU Group
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引用次数: 0

Abstract

Objective

To describe the safety and feasibility of a fast-track pathway for neurosurgical craniotomy patients receiving care in a neurosciences progressive care unit (NPCU).

Patients and Methods

Traditionally, most craniotomy patients are admitted to the neurosciences intensive care unit (NSICU) for postoperative follow-up. Decreased availability of NSICU beds during the coronavirus disease-2019 delta surge led our team to establish a de-novo NPCU to preserve capacity for patients requiring high level of care and would bypass routine NSICU admissions. Patients were selected a priori by treating neurosurgeons on the basis of the potential need for high-level ICU services. After operation, selected patients were transferred to the postoperative care unit, where suitability for NPCU transfer was reassessed with checklist-criteria. This process was continued after the delta surge.

Results

From July 1, 2021 to September 30, 2022, 57 patients followed the NPCU protocol. Thirty-four (59.6%) were women, and the mean age was 56 years. Fifty-seven craniotomies for 34 intra-axial and 23 extra-axial lesions were performed. After assessment and application of the checklist-criteria, 55 (96.5%) were transferred to NPCU, and only 2 (3.5%) were transferred to ICU. All 55 patients followed in NPCU had good safety outcomes without requiring NSICU transfer. This saved $143,000 and led to 55 additional ICU beds for emergent admissions.

Conclusion

This fast-track craniotomy protocol provides early experience that a surgeon-selected group of patients may be suitably monitored outside the traditional NSICU. This system has the potential to reduce overall health care expenses, increase capacity for NSICU bed availability, and change the paradigm of NSICU admission.

神经外科开颅患者快速通道的安全性和可行性:绕过重症监护病房
目的探讨神经外科开颅手术患者在神经科学进展监护病房(NPCU)接受治疗的快速通道的安全性和可行性。传统上,大多数开颅手术患者都住进神经科学重症监护病房(NSICU)进行术后随访。在冠状病毒病-2019三角洲激增期间,NSICU床位的可用性减少,导致我们的团队建立了一个新的NPCU,以保持对需要高水平护理的患者的能力,并将绕过常规的NSICU入院。患者是由治疗神经外科医生根据对高水平ICU服务的潜在需求先验选择的。手术后,选定的患者被转移到术后护理病房,在那里用检查表标准重新评估NPCU转移的适用性。这一过程在三角洲浪涌之后继续进行。结果2021年7月1日至2022年9月30日,57例患者遵循NPCU方案。女性34例(59.6%),平均年龄56岁。共开颅57例,轴内病变34例,轴外病变23例。经评估应用核对表标准后,55例(96.5%)转NPCU, 2例(3.5%)转ICU。所有55例NPCU随访患者均有良好的安全性结果,无需NSICU转移。这节省了14.3万美元,并增加了55张重症监护室床位,用于紧急收治。结论该快速开颅手术方案提供了早期经验,可以在传统的NSICU之外对外科医生选择的患者进行适当的监测。该系统有可能降低整体医疗费用,增加NSICU床位的可用性,并改变NSICU入院的模式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Mayo Clinic proceedings. Innovations, quality & outcomes
Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy
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