A 4-year Retrospective on the Postoperative Admission of Posterior Fossa Tumor Resection Patients to the Neuroscience Ward vs. ICU

Introduction: Current standard of care following resection of a posterior fossa tumor involves direct admission to the neurosurgical intensive care unit (ICU) from the operating room. Previous research reports on outcomes for supratentorial brain tumors, but little data is available for posterior fossa tumors specifically. This was especially pertinent during the COVID-19 pandemic as ICU space was often limited. This study reports the results of four years of direct admission to the neuroscience ward following recovery in the post-anesthesia care unit (PACU).

Methods: A retrospective study of a single surgeon cohort of all posterior fossa tumor patients who underwent resections from 2018-2022 was performed, with a total of 54 patients being recorded. Measures of performance were calculated from the data collected.

Results: Mean Length of Stay (LOS) was found to be 1.61 days with only a single 30-day readmission being recorded during the time frame. Inflation adjusted cost savings for the patient totaled to be on average $9,772.12 assuming non-use of a ventilator. No transfers from the ward to the ICU were found. 30/54 (55.56%) of the patients were successfully discharged on post-operative day one with seven being discharged same day. With no 30-day readmissions or post-operative complications amongst the post-op day one or day zero cohort being recorded

Conclusion : The results of this retrospective study demonstrate that omission of ICU care is certainly feasible following posterior fossa tumor resection, with our results reporting a significantly reduced mean LOS as well as significant cost-savings for the patient and hospital without a compromise in outcomes. This is especially pertinent as many of these cases occurred during the COVID-19 pandemic during crisis standards of care when ICU space was often at a premium. Future research still needs to be conducted on a larger cohort of patients but this is a promising first step.