No Routine Postoperative Head CT following Elective Craniotomy - A Paradigm Shift?


Autoria(s): Schär, Ralph; Fiechter, Michael; Z'Graggen, Werner Josef; Soell, Nicole; Krejci, Vladimir; Wiest, Roland; Raabe, Andreas; Beck, Jürgen
Data(s)

2016

Resumo

INTRODUCTION Patient management following elective cranial surgery often includes routine postoperative computed tomography (CT). We analyzed whether a regime of early extubation and close neurological monitoring without routine CT is safe, and compared the rate of postoperative emergency neurosurgical intervention with published data. METHODS Four hundred ninety-two patients were prospectively analyzed; 360 had supra- and 132 had infratentorial lesions. Extubation within one hour after skin closure was aimed for in all cases. CT was performed within 48 hours only in cases of unexpected neurological findings. RESULTS Four-hundred sixty-nine of the 492 patients (95.3%) were extubated within one hour, 20 (4.1%) within 3 hours, and three (0.6%) within 3 to 10 hours. Emergency CT within 48 hours was performed for 43/492 (8.7%) cases. Rate of recraniotomy within 48 hours for patients with postoperative hemorrhage was 0.8% (n = 4), and 0.8% (n = 4) required placement of an external ventricular drain (EVD). Of 469 patients extubated within one hour, 3 required recraniotomy and 2 required EVD placements. Of 23 patients with delayed extubation, 1 recraniotomy and 2 EVDs were required. Failure to extubate within one hour was associated with a significantly higher risk of surgical intervention within 48 hours (rate 13.0%, p = 0.004, odds ratio 13.9, 95% confidence interval [3.11-62.37]). DISCUSSION Early extubation combined with close neurological monitoring is safe and omits the need for routine postoperative CT. Patients not extubated within one hour do need early CT, since they had a significantly increased risk of requiring emergency neurosurgical intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT01987648.

Formato

application/pdf

Identificador

http://boris.unibe.ch/81256/1/asset.pdf

Schär, Ralph; Fiechter, Michael; Z'Graggen, Werner Josef; Soell, Nicole; Krejci, Vladimir; Wiest, Roland; Raabe, Andreas; Beck, Jürgen (2016). No Routine Postoperative Head CT following Elective Craniotomy - A Paradigm Shift? PLoS ONE, 11(4), e0153499. Public Library of Science 10.1371/journal.pone.0153499 <http://dx.doi.org/10.1371/journal.pone.0153499>

doi:10.7892/boris.81256

info:doi:10.1371/journal.pone.0153499

info:pmid:27077906

urn:issn:1932-6203

Idioma(s)

eng

Publicador

Public Library of Science

Relação

http://boris.unibe.ch/81256/

Direitos

info:eu-repo/semantics/openAccess

Fonte

Schär, Ralph; Fiechter, Michael; Z'Graggen, Werner Josef; Soell, Nicole; Krejci, Vladimir; Wiest, Roland; Raabe, Andreas; Beck, Jürgen (2016). No Routine Postoperative Head CT following Elective Craniotomy - A Paradigm Shift? PLoS ONE, 11(4), e0153499. Public Library of Science 10.1371/journal.pone.0153499 <http://dx.doi.org/10.1371/journal.pone.0153499>

Palavras-Chave #610 Medicine & health
Tipo

info:eu-repo/semantics/article

info:eu-repo/semantics/publishedVersion

PeerReviewed