Objectives: 

The standard-of-care for postoperative care following elective craniotomy has historically been ICU admission. However, recent literature interrogating complications and interventions during this postoperative ICU stay suggests that all patients may not require this level of care. Thus, hospitals began implementing non-ICU postoperative care pathways for elective craniotomy. This systematic review aims to summarize and evaluate the existing literature regarding outcomes and costs for patients receiving non-ICU care after elective craniotomy.

Data Sources: 

A systematic review of the PubMed database was performed following PRISMA guidelines from database inception to August 2021.

Study Selection: 

Included studies were published in peer-reviewed journals, in English, and described outcomes for patients undergoing elective craniotomies without postoperative ICU care.

Data Extraction: 

Data regarding study design, patient characteristics, and postoperative care pathways were extracted independently by two authors. Quality and risk of bias were evaluated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence tool and Risk Of Bias In Non-Randomized Studies—of Interventions tool, respectively.

Data Synthesis: 

In total, 1,131 unique articles were identified through the database search, with 27 meeting inclusion criteria. Included articles were published from 2001 to 2021 and included non-ICU inpatient care and same-day discharge pathways. Overall, the studies demonstrated that postoperative non-ICU care for elective craniotomies led to length of stay reduction ranging from 6 hours to 4 days and notable cost reductions. Across 13 studies, 53 of the 2,469 patients (2.1%) intended for postoperative management in a non-ICU setting required subsequent care escalation.

Conclusions: 

Overall, these studies suggest that non-ICU care pathways for appropriately selected postcraniotomy patients may represent a meaningful opportunity to improve care value. However, included studies varied greatly in patient selection, postoperative care protocol, and outcomes reporting. Standardization and multi-institutional collaboration are needed to draw definitive conclusions regarding non-ICU postoperative care for elective craniotomy.

中文翻译：

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重新审视接受选择性开颅手术的患者术后入住 ICU 的作用：系统评价

目标： 

选择性开颅术后术后护理的标准护理历来是入住 ICU。然而，最近有关术后 ICU 住院期间并发症和干预措施的文献表明，并非所有患者都需要这种级别的护理。因此，医院开始实施选择性开颅手术的非 ICU 术后护理途径。本系统评价旨在总结和评估关于择期开颅术后接受非 ICU 护理的患者的结局和费用的现有文献。

数据源： 

从数据库开始到 2021 年 8 月，按照 PRISMA 指南对 PubMed 数据库进行了系统审查。

研究选择： 

纳入的研究以英文发表在同行评审期刊上，并描述了在没有术后 ICU 护理的情况下接受选择性开颅手术的患者的结果。

数据提取： 

有关研究设计、患者特征和术后护理途径的数据由两位作者独立提取。质量和偏倚风险分别使用牛津循证医学中心证据水平工具和非随机研究中的偏倚风险——干预工具进行评估。

数据合成： 

通过数据库搜索总共确定了 1,131 篇独特的文章，其中 27 篇符合纳入标准。纳入的文章发表于 2001 年至 2021 年，包括非 ICU 住院护理和当日出院途径。总体而言，研究表明，选择性开颅手术的术后非 ICU 护理可减少 6 小时至 4 天的住院时间，并显着降低成本。在 13 项研究中，2,469 名患者中有 53 名（2.1%）打算在非 ICU 环境中进行术后管理，需要后续护理升级。

结论： 

Overall, these studies suggest that non-ICU care pathways for appropriately selected postcraniotomy patients may represent a meaningful opportunity to improve care value. 然而，纳入的研究在患者选择、术后护理方案和结果报告方面差异很大。需要标准化和多机构合作才能得出关于择期开颅手术非 ICU 术后护理的明确结论。