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

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

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Schär, Ralph; Fiechter, Michael; Z'Graggen, Werner Josef; Soell, Nicole; Krejci, Vladimir; Wiest, Roland; Raabe, Andreas and Beck, Jürgen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

08 Jun 2016 13:20

Last Modified:

23 Jan 2018 12:14

Publisher DOI:

10.1371/journal.pone.0153499

PubMed ID:

27077906

BORIS DOI:

10.7892/boris.81256

URI:

https://boris.unibe.ch/id/eprint/81256

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