Risk Factors Associated with Necessity for Intensive Care Utilization in Lateral Skull Base Surgery

Introduction: Many patients who undergo elective lateral skull base surgery are routinely monitored in the intensive care unit (ICU) postoperatively. The rationale for ICU admission postoperatively is to provide the highest-level monitoring to detect devastating and potentially treatable complications early to improve patient outcomes. However, little is known about the utility of ICU management on patient outcomes in postoperative lateral skull base surgery, with some studies suggesting that intensive care has no effect on mortality rate or length of hospital stay. The aim of this study is to elucidate the relative rates of ICU interventions and identify patient centered risk factors that may warrant admission to the ICU to better utilize expensive hospital resources while ensuring optimum outcomes.

Methods: A retrospective chart review was conducted of patients who were admitted to the ICU after undergoing elective lateral skull base surgery for vestibular schwannomas. Patients were admitted to the ICU postoperatively for neurologic and hemodynamic monitoring. Patient demographics, preoperative comorbidities, tumor, and treatment characteristics were collected, as were complications and ICU interventions. Analysis was performed to determine factors that may be associated with a complication or intervention that occurred in the ICU setting. Univariate and three-way analysis of variance was performed comparing groups, and multivariate logistic regression was used to determine adjusted odds ratios for analyzed factors.

Results: There were 2 patients with ICU complications and 15 who required ICU level intervention for a total of 17 (8.5%) patients requiring ICU level care. Forty-six additional patients sustained a medical or surgical complication outside the ICU setting. Patients who were on aspirin prior to surgery (p = 0.045), those with hypertension (p = 0.001), and those with larger tumor volume (p = 0.039) were more likely to require ICU intervention. No other factor analyzed was significantly associated with ICU interventions. When controlling for age, gender, obesity, and other comorbidities, we found that only hypertension (aOR: 5.43, 95% CI: 1.35–21.73, p = 0.017) and tumor volume (aOR: 3.29, 95% CI: 1.09–9.96, p = 0.035) were independently associated with increased risk of ICU complications.

Conclusion: The necessity for intensive care interventions after resection of vestibular schwannomas is very rare, primarily consisting of hemodynamic monitoring and blood pressure control. History of hypertension and larger tumor volume (over 4,500 mm³) were independently associated with increased need for ICU level care. Patients with hypertension and large tumor volume should be monitored in the ICU following surgical resection of vestibular schwannomas. Those with small tumors who are otherwise healthy may be monitored in the postanesthesia care unit and individually risk stratified for transfer to step down units where appropriate.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021