• Farhan A Mirza, Catherine Wang, and Thomas Pittman.
• a Department of Neurosurgery , University of Kentucky , Lexington , KY , USA.
• Br J Neurosurg. 2018 Apr 1; 32 (2): 201-205.

ObjectiveWe reviewed the safety of our practice of admitting patients who have undergone a craniotomy for resection of an intra-axial brain tumor to a floor bed instead of an ICU. We also tried to quantify the risk that patients electively admitted to the ICU would develop a problem that could not have been effectively managed on the ward.MethodsA retrospective chart review was performed of both adult and pediatric patients who underwent craniotomy by the senior author for resection of an intra-axial brain tumor between January 2012 and December 2015. 413 patient charts were reviewed; 16 patients were omitted due to incomplete records.ResultsFour hundred twenty-one craniotomies (393 supratentorial, 28 infratentorial) were performed in 397 patients, 35 of whom were <18 years of age. Three hundred fifty-five patients (83%) were admitted to floor beds; 4 (1.1%) developed complications that required transfer to an ICU. None of the 4 died or had lasting disability. Sixty-six patients, 51 adults and 15 children, were admitted to the ICU after their operation. Twenty-five of these patients had an absolute indication for ICU admission: 9 required a ventilator, 14 had an EVD and 2 were medically unstable. Of the remaining 41, none developed a complication that would have required transfer to an ICU had they been on the ward.ConclusionIt is safe to admit almost all patients to a floor bed after craniotomy for intra-axial brain tumor resection. The risk of a catastrophic problem occurring after a 4 hour stay in the post anesthesia care unit is extremely low. Furthermore, even patients who are electively managed in an ICU are unlikely to develop problems that would lead to a worse outcome had they been in a floor bed.

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