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Timing of complications following elective craniotomies
Background: Conservative prolonged observation periods after elective craniotomies with admission to neurosurgical higher or intensive care units (ICU) have been the norm for many decades. This practice is neither evidence based nor a cost-effective use of medical resources. This...
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| Format: | Thesis |
| Language: | English |
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Department of Anaesthesia and Perioperative Medicine
2022
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| _version_ | 1867613162708140032 |
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| access_status_str | Open Access |
| author | Claassens, Caren |
| author2 | Reed, Anthony |
| author_browse | Claassens, Caren Reed, Anthony |
| author_facet | Reed, Anthony Claassens, Caren |
| author_sort | Claassens, Caren |
| collection | Thesis |
| description | Background: Conservative prolonged observation periods after elective craniotomies with admission to neurosurgical higher or intensive care units (ICU) have been the norm for many decades. This practice is neither evidence based nor a cost-effective use of medical resources. This observational audit aimed to establish the incidence and timing of serious complications after elective craniotomies in a low-middle income country context. Methods: The medical records of adult patients who had elective craniotomies for the 2-year period of March 2016-February 2018 at Groote Schuur Hospital were reviewed. Complication incidence and timing was analysed in all patients admitted to either the neurosurgical high care unit (HCU) or ICU post-operatively for the initial 24hr period. The specific complications in our audit was defined as: a decrease in Glascow Coma Scale (GCS) of more than 2 points from the preoperative baseline score, new onset or worsening motor deficit, seizures, diabetes insipidus, haemodynamic instability, severe hypertension, tracheal intubation or noninvasive ventilatory support, and death. Statistical analysis was primarily descriptive. Results: A total of 189 elective craniotomy patients were included in our audit for the 2-year period mentioned. In this study 37/189 (19.6%) patients developed 1 or more major complications during the initial 24 hr post-operative period. Of these 37 patients, 31 (83.8% [95% CI 71.9-95.7]) patients developed their first onset complication within six hours of admission to the HCU or ICU, and the remaining 6 (16.2% [95% CI 4.3-28.1]) in the subsequent 18 hours. All patients who developed life threatening complications (airway, ventilation or haemodynamic support) had their first onset complication (“red flag”) within six hrs of admission. Conclusion: Our audit suggests that consideration should be given to discharge patients to a general neurosurgical ward after an uncomplicated six hour postoperative ICU stay. While a significant amount of first onset complications may occur if a patient is discharged to the neurosurgical ward after this time period, these complications were unlikely to be immediately life threatening and should not require more than standard neurosurgical ward observations to detect. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/35703 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:31:45.395Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Department of Anaesthesia and Perioperative Medicine |
| publisherStr | Department of Anaesthesia and Perioperative Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/35703 Timing of complications following elective craniotomies Claassens, Caren Reed, Anthony Semple, Patrick Anaesthesiology Background: Conservative prolonged observation periods after elective craniotomies with admission to neurosurgical higher or intensive care units (ICU) have been the norm for many decades. This practice is neither evidence based nor a cost-effective use of medical resources. This observational audit aimed to establish the incidence and timing of serious complications after elective craniotomies in a low-middle income country context. Methods: The medical records of adult patients who had elective craniotomies for the 2-year period of March 2016-February 2018 at Groote Schuur Hospital were reviewed. Complication incidence and timing was analysed in all patients admitted to either the neurosurgical high care unit (HCU) or ICU post-operatively for the initial 24hr period. The specific complications in our audit was defined as: a decrease in Glascow Coma Scale (GCS) of more than 2 points from the preoperative baseline score, new onset or worsening motor deficit, seizures, diabetes insipidus, haemodynamic instability, severe hypertension, tracheal intubation or noninvasive ventilatory support, and death. Statistical analysis was primarily descriptive. Results: A total of 189 elective craniotomy patients were included in our audit for the 2-year period mentioned. In this study 37/189 (19.6%) patients developed 1 or more major complications during the initial 24 hr post-operative period. Of these 37 patients, 31 (83.8% [95% CI 71.9-95.7]) patients developed their first onset complication within six hours of admission to the HCU or ICU, and the remaining 6 (16.2% [95% CI 4.3-28.1]) in the subsequent 18 hours. All patients who developed life threatening complications (airway, ventilation or haemodynamic support) had their first onset complication (“red flag”) within six hrs of admission. Conclusion: Our audit suggests that consideration should be given to discharge patients to a general neurosurgical ward after an uncomplicated six hour postoperative ICU stay. While a significant amount of first onset complications may occur if a patient is discharged to the neurosurgical ward after this time period, these complications were unlikely to be immediately life threatening and should not require more than standard neurosurgical ward observations to detect. 2022-02-18T04:41:22Z 2022-02-18T04:41:22Z 2021 2022-02-09T13:14:17Z Master Thesis Masters MMed http://hdl.handle.net/11427/35703 eng application/pdf Department of Anaesthesia and Perioperative Medicine Faculty of Health Sciences |
| spellingShingle | Anaesthesiology Claassens, Caren Timing of complications following elective craniotomies |
| thesis_degree_str | Master's |
| title | Timing of complications following elective craniotomies |
| title_full | Timing of complications following elective craniotomies |
| title_fullStr | Timing of complications following elective craniotomies |
| title_full_unstemmed | Timing of complications following elective craniotomies |
| title_short | Timing of complications following elective craniotomies |
| title_sort | timing of complications following elective craniotomies |
| topic | Anaesthesiology |
| url | http://hdl.handle.net/11427/35703 |
| work_keys_str_mv | AT claassenscaren timingofcomplicationsfollowingelectivecraniotomies |