The necessity for routine intensive care unit admission following elective craniotomy for epilepsy surgery: a retrospective single-center observational study

OBJECTIVE Traditionally, patients who underwent elective craniotomy for epilepsy surgery are monitored postopera-tively in an intensive care unit (ICU) overnight in order to sufficiently respond to potential early postoperative compli- cations. In the present study, the authors investigated the frequency of early postoperative events that entailed ICU monitoring in patients who had undergone elective craniotomy for epilepsy surgery. In a second step, they aimed at identifying pre-and intraoperative risk factors for the development of unfavorable events to distinguish those patients with the need for postoperative ICU monitoring at the earliest possible stage. METHODS The authors performed a retrospective observational cohort study assessing patients with medically intractable epilepsy (n = 266) who had undergone elective craniotomy for epilepsy surgery between 2012 and 2019 at a tertiary care epilepsy center, excluding those patients who had undergone invasive diagnostic approaches and func-tional hemispherectomy. Postoperative complications were defined as any unfavorable postoperative surgical and/or anesthesiological event that required further ICU therapy within 48 hours following surgery. A multivariate analysis was performed to reveal preoperatively identifiable risk factors for postoperative adverse events requiring an ICU setting. RESULTS Thirteen (4.9%) of 266 patients developed early postoperative adverse events that required further postoper-ative ICU care. The most prevalent event was a return to the operating room because of relevant postoperative intracra-nial hematoma (5 of 266 patients). Multivariate analysis revealed intraoperative blood loss >= 325 ml (OR 6.2, p = 0.012) and diabetes mellitus (OR 9.2, p = 0.029) as risk factors for unfavorable postoperative events requiring ICU therapy. CONCLUSIONS The present study revealed routinely collectable risk factors that would allow the identification of patients with an elevated risk of postsurgical complications requiring a postoperative ICU stay following epilepsy surgery. These findings may offer guidance for a stepdown unit admission policy following epilepsy surgical interventions after an external validation of the results.