Evaluating Patient Outcomes of Postoperative Admission to the Neurosurgery Floor compared to the Intensive Care Unit Following Supratentorial Craniotomy for Brain Tumor Resection

Introduction: Craniotomy for tumor resection traditionally involves admission to the intensive care unit (ICU) for postoperative monitoring. During the COVID-19 epidemic, all patients who underwent uncomplicated craniotomy for tumor resection were admitted to a regular med-surg floor allowing ICU beds to be reserved for critically ill patients. The objective of this study was to evaluate the safety of this approach and its impact on length of stay (LOS). Methods: A retrospective chart review was conducted on adult patients receiving supratentorial craniotomy for resection of glioma, meningioma, or a metastatic lesion(s), between January 2017 and October 2023 by a single surgeon at our institution. Medical records were reviewed to assess postoperative admission location and complications, which were compared across pre-COVID-19 (2017-2019) and post-COVID-19 (2021-2023) time periods. Comparisons were evaluated by Fisher’s exact test, Wilcoxon rank sum test, and multivariable logistic regression models. Results: Pre-COVID-19, 6% of patients (n = 8) were admitted to the neurosurgery floor whereas 48% of patients (n = 69) were admitted to the floor postop post-COVID-19. Patient demographics, tumor type, tumor location, and Charlson Comorbidity Index (CCI) were similar across both time periods, indicating comparable patient characteristics in the pre-COVID and post-COVID cohorts. Pre-COVID-19 patients admitted to the floor had a trend for reduced LOS (mean (SD): 3.8 (3.2) vs. 5.0 (3.9), p = 0.3) and fewer postoperative complications (12.5% vs. 58.9%, p>0.9). Post-COVID-19, these trends became more statistically significant as the number of patients admitted to the floor, and power, increased. Patients admitted to the floor in the post-COVID-19 era had significantly reduced LOS (3.4 (SD 3.5) vs. 7.1 (SD 9.1) for ICU patients, p<0.001). 30-day readmission rates for patients admitted to the floor demonstrated a decreased trend from pre- to post-COVID-19 (37.5% vs. 14.5%) Conclusion: At our institution, postoperative admission to the neurosurgery floor for supratentorial craniotomy significantly reduced LOS without increased readmissions. Use of ICU beds can be reserved for critically ill patients while reducing LOS of post-craniotomy patients by sending them to the floor after surgery.