Post-operative intensive care unit admission for elective brain tumour surgeries: A Nigerian neurosurgical unit experience

Abstract

Background: Patients, post elective brain tumour surgeries, are usually admitted into the Intensive Care Unit (ICU) for quick  identification of life-threatening complications or for elective ventilation. The Covid-19 pandemic exerted additional strain on the limited  ICU spaces. This study was to probe the need for ICU admission following elective surgery for brain tumour in our environment on the  background of enormous constraints.

Methods: Data was collected prospectively from patients who had elective brain tumour surgery  over 12-months at the University College Hospital, Ibadan. Data included the indications for ICU admission and outcome. Chi-square test  and Student t-test were used for analysis at α < 0.05.

Results: There were 56 patients with a mean age of 44.6 years and M:F ratio of 1:1. 61.8% of the patients were admitted into the ICU for observation. Patients who had open surgeries were 2 times more likely to be  admitted (p<0.01; OR = 2.2, CI: 2.0 – 36.8) than those who had endoscopic surgeries. Awake craniotomy patients did not require ICU care  compared with the 63% of the patients who had General Anaesthesia + Endo Tracheal Tube (GA+ETT). Patients with skull base and  posterior fossa tumours were more likely to be admitted into the ICU (p=0.036). Of the 34 patients admitted into the ICU, 11(19.6%) had  prolonged ICU stay and were 2 times more likely to die compared with those with short admissions (p<0.01; OR = 2.5, CI: 2.29 – 70.02).  

Conclusion: Observation is the main reason patients are admitted into the ICU. The endoscopic and awake surgery approaches appear to  preclude the need for ICU admission, thus capable of cutting costs.