{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:50:40Z","timestamp":1786125040615,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2021,6,5]],"date-time":"2021-06-05T00:00:00Z","timestamp":1622851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>There is a growing body of evidence suggesting not all craniotomy patients require postoperative intensive care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To devise and implement a standardized protocol for craniotomy patients eligible to transition directly from the operating room to the ward\u2014the Non-Intensive CarE (NICE) protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We preoperatively identified patients undergoing elective craniotomy for simple neurosurgical procedures with age &lt;65 yr and American Society of Anesthesiologists (ASA) class of 1, 2 or 3. Postoperative eligibility was confirmed by the surgical and anesthesia teams. Upon arrival to the ward, patients were staffed with a neuroscience nurse for hourly neurological examinations for the first 8 h. Patient demographics, clinical characteristics, and outcomes were prospectively collected to evaluate the NICE protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>From February 2018 to 2019, 63 patients were included in the NICE protocol with a median age of 46 yr and 65% female predominance. Of the operations performed, 38.1% were microvascular decompressions, 31.7% were craniotomy for tumor, 15.9% were cavernous malformation resections, and 14.3% were Chiari decompressions. No patients required transfer to the intensive care unit (ICU). Median length of stay was 2 d. There was an 11.1% overall readmission rate within the median follow-up period of 48 d. Three patients (4.8%) required reoperation at time of readmission within the follow-up period (1 postoperative subdural hematoma, 2 cerebrospinal fluid leak repair). None of these complications could have been identified with a postoperative ICU stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>In our pilot trial of the NICE protocol, no patients required postoperative transfer to the ICU.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyab187","type":"journal-article","created":{"date-parts":[[2021,5,9]],"date-time":"2021-05-09T15:06:19Z","timestamp":1620572779000},"page":"471-477","source":"Crossref","is-referenced-by-count":9,"title":["A Novel Protocol for Reducing Intensive Care Utilization After Craniotomy"],"prefix":"10.1227","volume":"89","author":[{"given":"Arjun V","family":"Pendharkar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam N","family":"Shahin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohun S","family":"Awsare","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen L","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Wachira","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnathan","family":"Clevinger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sveinn","family":"Sigurdsson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy C","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie Hayden","family":"Gephart","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,9]]},"reference":[{"issue":"5","key":"bib1-20231012","doi-asserted-by":"crossref","first-page":"E19","DOI":"10.3171\/2018.2.FOCUS1812","article-title":"Cost-effectiveness development for the postoperative care of craniotomy patients: a safe transitions pathway in neurological surgery","volume":"44","author":"Osorio","year":"2018","journal-title":"Neurosurg Focus"},{"key":"bib2-20231012","article-title":"A safe transitions pathway for post-craniotomy neurological surgery patients: high-value care that bypasses the intensive care unit [published online ahead of print, 2020 May 29]","author":"Young","journal-title":"J Neurosurg"},{"issue":"6","key":"bib3-20231012","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.3171\/2016.5.JNS152118","article-title":"Utility of the intensive care unit in patients undergoing microvascular decompression: a multiinstitution comparative analysis","volume":"126","author":"Lawrence","year":"2017","journal-title":"J Neurosurg"},{"issue":"1","key":"bib4-20231012","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s12028-017-0433-4","article-title":"The utility of routine intensive care admission for patients undergoing intracranial neurosurgical procedures: a systematic review","volume":"28","author":"de Almeida","year":"2018","journal-title":"Neurocrit Care"},{"issue":"1","key":"bib5-20231012","doi-asserted-by":"crossref","first-page":"E54","DOI":"10.1093\/neuros\/nyz388","article-title":"Selective intensive care unit admission after adult supratentorial tumor craniotomy: complications, length of stay, and costs","volume":"86","author":"Laan M","year":"2020","journal-title":"Neurosurgery"},{"issue":"6","key":"bib6-20231012","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.3171\/2016.10.JNS16954","article-title":"A protocol for postoperative admission of elective craniotomy patients to a non-ICU or step-down setting","volume":"127","author":"Florman","year":"2017","journal-title":"J Neurosurg"},{"issue":"5","key":"bib7-20231012","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1097\/ACO.0000000000000503","article-title":"Criteria for intensive care admission and monitoring after elective craniotomy","volume":"30","author":"Badenes","year":"2017","journal-title":"Curr Opin Anaesthesiol"},{"issue":"1","key":"bib8-20231012","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.wneu.2012.11.068","article-title":"Postoperative intensive care unit requirements after elective craniotomy","volume":"81","author":"Hanak","year":"2014","journal-title":"World Neurosurg"},{"issue":"6","key":"bib9-20231012","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/S0090-3019(03)00517-2","article-title":"Routine use of postoperative ICU care for elective craniotomy: a cost-benefit analysis","volume":"60","author":"Beauregard","year":"2003","journal-title":"Surg Neurol"},{"issue":"4","key":"bib10-20231012","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.accpm.2016.06.012","article-title":"Postoperative complications after craniotomy for brain tumor surgery","volume":"36","author":"Lonjaret","year":"2017","journal-title":"Anaesth Crit Care Pain Med"},{"issue":"1","key":"bib11-20231012","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1093\/neuros\/nyz353","article-title":"Simulating episode-based bundled payments for cranial neurosurgical procedures","volume":"87","author":"Medress","year":"2020","journal-title":"Neurosurgery"},{"issue":"6","key":"bib13-20231012","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.3171\/2011.8.JNS11105","article-title":"Is postoperative intensive care unit admission a prerequisite for elective craniotomy?","volume":"115","author":"Bui","year":"2011","journal-title":"J Neurosurg"},{"key":"bib14-20231012","doi-asserted-by":"crossref","first-page":"e381","DOI":"10.1016\/j.wneu.2020.02.130","article-title":"The utility of early postoperative neuroimaging in elective\/semielective craniotomy patients: a single-arm prospective trial","volume":"138","author":"Ben Zvi","year":"2020","journal-title":"World Neurosurg"},{"issue":"1","key":"bib15-20231012","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.wneu.2013.01.119","article-title":"Routine intensive care unit-level care after elective craniotomy: time to rethink","volume":"81","author":"Hecht","year":"2014","journal-title":"World Neurosurg"},{"key":"bib16-20231012","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jocn.2018.10.110","article-title":"Hospital costs associated with inpatient versus outpatient awake craniotomy for resection of brain tumors","volume":"59","author":"Nassiri","year":"2019","journal-title":"J Clin Neurosci"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/89\/3\/471\/39628889\/nyab187.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyab187","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:49:22Z","timestamp":1786121362000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyab187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,5]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyab187","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,5]]}}}