A 6-year Retrospective Study on the Postoperative Admission of Skull-base Meningioma Resection Patients to the Neuroscience Ward vs. ICU

Introduction: Skull-base meningiomas present as a unique challenge, not only due to their highly vascularized nature but additionally in their difficulty to access. Thus, current standard of care involves admitting these patients post-resection directly to the intensive care unit (ICU), with previous studies consistently reporting a length of stay (LOS) of over a week. 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 skull-base meningioma patients who underwent resections from 2016-2022 was performed, with a total of 44 patients being recorded.

Results: Mean Length of Stay (LOS) was found to be 1.91 days with one 30-day readmission being recorded during the time frame. Inflation adjusted cost savings for the patient totaled to be on average $11,437.10 assuming non-use of a ventilator and reduced LOS. No transfers from the ward to the ICU were found. 20/44 (45.45%) of the patients were successfully discharged within one day post-operatively. 15/44 (34.09%) were discharged on the second day post-operatively.

Conclusion : The results of this retrospective study demonstrate that omission of ICU care following skull-base meningiomas resection can potentially lead to 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. Further data still needs to be collected to support these outcomes, but offers a sign of an effective means of management for these complex tumors.