Laurent Lonjaret1, Marine Guyonnet2, Emilie Berard3, Marc Vironneau4, Françoise Peres5, Sandrine Sacrista6, Anne Ferrier7, Véronique Ramonda8, Corine Vuillaume9, Franck-Emmanuel Roux10, Olivier Fourcade11, Thomas Geeraerts12. 1. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: laurent.lonjaret@laposte.net. 2. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: marineguyonnet.83@hotmail.fr. 3. Department of Epidemiology, HealthEconomics and public health, UMR-1027 Inserm, Toulouse University Hospital, Toulouse, France. Electronic address: emilie.berard@univ-tlse3.fr. 4. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: vironneau.m@chu-toulouse.fr. 5. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: peres.f@chu-toulouse.fr. 6. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: sacrista.s@chu-toulouse.fr. 7. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: ferrier-lewis.a@chu-toulouse.fr. 8. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: ramonda.v@chu-toulouse.fr. 9. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: vuillaume.c@chu-toulouse.fr. 10. Department of Neurosurgery, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: roux.fe@chu-toulouse.fr. 11. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: fourcade.o@chu-toulouse.fr. 12. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse 3-Paul-Sabatier, Toulouse, France. Electronic address: geeraerts.t@chu-toulouse.fr.
Abstract
INTRODUCTION: After elective craniotomy for brain tumour surgery, patients are usually admitted to an intensive care unit (ICU) for monitoring. Our goal was to evaluate the incidence and timing of neurologic and non-neurologic postoperative complications after brain tumour surgery, to determine factors associated with neurologic events and to evaluate the timing and causes of ICU readmission. PATIENTS AND METHODS: This prospective, observational and analytic study enrolled 188 patients admitted to the ICU after brain tumour surgery. All postoperative clinical events during the first 24hours were noted and classified. Readmission causes and timing were also analysed. RESULTS: Twenty-one (11%) of the patients were kept sedated after surgery; the remaining 167 patients were studied. Thirty one percent of the patients presented at least one complication (25% with postoperative nausea and vomiting (PONV), 16% with neurologic complications). The occurrence of neurological complications was significantly associated with the absence of preoperative motor deficit and the presence of higher intraoperative bleeding. Seven patients (4%) were readmitted to the ICU after discharge; 43% (n=3) of them had a posterior fossa surgery. CONCLUSION: Postoperative complications, especially PONV, are frequent after brain tumour surgery. Moreover, 16% of patients presented a neurological complication, probably justifying the ICU postoperative stay for early detection. The absence of preoperative motor deficit and intraoperative bleeding seems to predict postoperative neurologic complications. Finally, patients may present complications after ICU discharge, especially patients with fossa posterior surgery, suggesting that ICU hospitalization may be longer in this type of surgery.
INTRODUCTION: After elective craniotomy for brain tumour surgery, patients are usually admitted to an intensive care unit (ICU) for monitoring. Our goal was to evaluate the incidence and timing of neurologic and non-neurologic postoperative complications after brain tumour surgery, to determine factors associated with neurologic events and to evaluate the timing and causes of ICU readmission. PATIENTS AND METHODS: This prospective, observational and analytic study enrolled 188 patients admitted to the ICU after brain tumour surgery. All postoperative clinical events during the first 24hours were noted and classified. Readmission causes and timing were also analysed. RESULTS: Twenty-one (11%) of the patients were kept sedated after surgery; the remaining 167 patients were studied. Thirty one percent of the patients presented at least one complication (25% with postoperative nausea and vomiting (PONV), 16% with neurologic complications). The occurrence of neurological complications was significantly associated with the absence of preoperative motor deficit and the presence of higher intraoperative bleeding. Seven patients (4%) were readmitted to the ICU after discharge; 43% (n=3) of them had a posterior fossa surgery. CONCLUSION:Postoperative complications, especially PONV, are frequent after brain tumour surgery. Moreover, 16% of patients presented a neurological complication, probably justifying the ICU postoperative stay for early detection. The absence of preoperative motor deficit and intraoperative bleeding seems to predict postoperative neurologic complications. Finally, patients may present complications after ICU discharge, especially patients with fossa posterior surgery, suggesting that ICU hospitalization may be longer in this type of surgery.
Authors: Mark Ter Laan; Suzanne Roelofs; Ineke Van Huet; Eddy M M Adang; Ronald H M A Bartels Journal: Neurosurgery Date: 2020-01-01 Impact factor: 4.654