{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:45:44Z","timestamp":1792176344420,"version":"4.4.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,8]]},"abstract":"OBJECTIVE<\/jats:title>Use of the ICU during admission to a hospital is associated with a significant portion of the total health care costs for that stay. Patients undergoing microvascular decompression (MVD) for cranial neuralgias are routinely admitted postoperatively to the ICU for monitoring. The primary purpose of this study was to compare complication rates of patients with and without a postoperative ICU stay following MVD. The secondary intents were to identify predictors of complications, to analyze variables of health care resource utilization, and to estimate the cost of postoperative management.<\/jats:p><\/jats:sec>METHODS<\/jats:title>The authors performed a retrospective comparative analysis of consecutive patients undergoing MVD at 2 institutions. A total of 199 patients without a postoperative ICU stay from Institution A and 119 patients with an ICU stay from Institution B were reviewed. Inclusion criteria included any adult (i.e., 18 years of age or older) undergoing MVD for trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, or geniculate neuralgia. Patients with incomplete medical records were excluded. Medical comorbidities, intraoperative variables, complications, postoperative interventions, and variables indicating health care resource utilization were reviewed.<\/jats:p><\/jats:sec>RESULTS<\/jats:title>The study compared 190 patients without a postoperative ICU stay from Institution A with 90 patients with an ICU stay from Institution B. Seven patients without an ICU stay and 5 patients with an ICU stay experienced complications after surgery (p = 0.53). Multivariate analysis identified coronary artery disease to be a predictor of complications (p = 0.037, OR 6.23, 95% CI 1.12\u201334.63). Patients from Institution A without a postoperative ICU stay had a significantly shorter length of stay, by approximately 16 hours (p < 0.001), and received less postoperative imaging (p < 0.001, OR 14.39, 95% CI 7.75\u201326.74) and postoperative diagnostic testing (p < 0.001) than patients from Institution B with an ICU stay. Estimated cost savings in patients without an ICU stay and 1 less day of inpatient recovery was calculated as $1400 per patient.<\/jats:p><\/jats:sec>CONCLUSIONS<\/jats:title>Selective versus routine use of ICU care as well as postoperative imaging and diagnostic testing may be safe after MVD and can lead to a reduction in overall health care costs.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.5.jns152118","type":"journal-article","created":{"date-parts":[[2016,8,12]],"date-time":"2016-08-12T18:26:49Z","timestamp":1471026409000},"page":"1967-1973","source":"Crossref","is-referenced-by-count":11,"title":["Utility of the intensive care unit in patients undergoing microvascular decompression: a multiinstitution comparative analysis"],"prefix":"10.3171","volume":"126","author":[{"given":"Jesse D.","family":"Lawrence","sequence":"first","affiliation":[{"name":"University of Pittsburgh School of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Tuchek","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron A.","family":"Cohen-Gadol","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University;"},{"name":"Goodman Campbell Brain and Spine; and"},{"name":"Simon Cancer Center, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond F.","family":"Sekula","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns152118","series-title":"Surg Neurol","doi-asserted-by":"publisher","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 CL,","year":"2003","unstructured":"Beauregard CL, Friedman WA: Routine use of postoperative ICU care for elective craniotomy: a cost-benefit analysis. Surg Neurol 60:483\u2013489, 489, 200310.1016\/S0090-3019(03)00517-214670660"},{"key":"b2-jns152118","series-title":"J Neurosurg","doi-asserted-by":"publisher","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 JQH,","year":"2011","unstructured":"Bui JQH, Mendis RL, van Gelder JM, Sheridan MMP, Wright KM, Jaeger M: Is postoperative intensive care unit admission a prerequisite for elective craniotomy?. J Neurosurg 115:1236\u20131241, 201110.3171\/2011.8.JNS1110521888476"},{"key":"b3-jns152118","series-title":"J Chronic Dis","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/0021-9681(87)90094-4","article-title":"The therapeutic efficacy of critical care units from two perspectives: a traditional cohort approach vs a new case-control methodology","volume":"40","author":"Charlson ME,","year":"1987","unstructured":"Charlson ME, Sax FL: The therapeutic efficacy of critical care units from two perspectives: a traditional cohort approach vs a new case-control methodology. J Chronic Dis 40:31\u201339, 198710.1016\/0021-9681(87)90094-4"},{"key":"b4-jns152118","series-title":"J Chronic Dis","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1016\/0021-9681(87)90107-X","article-title":"Morbidity during hospitalization: can we predict it?","volume":"40","author":"Charlson ME,","year":"1987","unstructured":"Charlson ME, Sax FL, MacKenzie CR, Braham RL, Fields SD, Douglas RG Jr: Morbidity during hospitalization: can we predict it?. J Chronic Dis 40:705\u2013712, 1987311019810.1016\/0021-9681(87)90107-X"},{"key":"b5-jns152118","series-title":"Arch Intern Med","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1001\/archinternmed.2012.2606","article-title":"Intensive care unit admitting patterns in the Veterans Affairs health care system","volume":"172","author":"Chen LM,","year":"2012","unstructured":"Chen LM, Render M, Sales A, Kennedy EH, Wiitala W, Hofer TP: Intensive care unit admitting patterns in the Veterans Affairs health care system. Arch Intern Med 172:1220\u20131226, 20122282580610.1001\/archinternmed.2012.2606"},{"key":"b6-jns152118","series-title":"J Healthc Manag","first-page":"421","article-title":"The high cost of low-acuity ICU outliers","volume":"57","author":"Dahl D,","year":"2012","unstructured":"Dahl D, Wojtal GG, Breslow MJ, Holl R, Huguez D, Stone D, : The high cost of low-acuity ICU outliers. J Healthc Manag 57:421\u2013434, 201223297608"},{"key":"b7-jns152118","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo D,","year":"2004","unstructured":"Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205\u2013213, 200410.1097\/01.sla.0000133083.54934.ae"},{"key":"b8-jns152118","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1097\/CCM.0b013e3181b090d0","article-title":"Critical care medicine in the United States 2000\u20132005: an analysis of bed numbers, occupancy rates, payer mix, and costs","volume":"38","author":"Halpern NA,","year":"2010","unstructured":"Halpern NA, Pastores SM: Critical care medicine in the United States 2000\u20132005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med 38:65\u201371, 20101973025710.1097\/CCM.0b013e3181b090d0"},{"key":"b9-jns152118","series-title":"World Neurosurg","doi-asserted-by":"publisher","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 BW,","year":"2014","unstructured":"Hanak BW, Walcott BP, Nahed BV, Muzikansky A, Mian MK, Kimberly WT, : Postoperative intensive care unit requirements after elective craniotomy. World Neurosurg 81:165\u2013172, 20142318273110.1016\/j.wneu.2012.11.068"},{"key":"b10-jns152118","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1227\/01.NEU.0000065129.25359.EE","article-title":"Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes","volume":"52","author":"Kalkanis SN,","year":"2003","unstructured":"Kalkanis SN, Eskandar EN, Carter BS, Barker FG II: Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 52:1251\u20131262, 20031276287010.1227\/01.NEU.0000065129.25359.EE"},{"key":"b11-jns152118","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"462","DOI":"10.3171\/2013.9.JNS13663","article-title":"Value-based neurosurgery: the example of microvascular decompression surgery","volume":"120","author":"McLaughlin N,","year":"2014","unstructured":"McLaughlin N, Buxey F, Chaw K, Martin NA: Value-based neurosurgery: the example of microvascular decompression surgery. J Neurosurg 120:462\u2013472, 201410.3171\/2013.9.JNS1366324286152"},{"key":"b12-jns152118","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"700","DOI":"10.3171\/2014.5.JNS131996","article-title":"Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery","volume":"121","author":"McLaughlin N,","year":"2014","unstructured":"McLaughlin N, Upadhyaya P, Buxey F, Martin NA: Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery. J Neurosurg 121:700\u2013708, 20142501444110.3171\/2014.5.JNS131996"},{"key":"b13-jns152118","series-title":"Can J Anaesth","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1007\/s12630-010-9393-2","article-title":"The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study","volume":"57","author":"Terada Y,","year":"2010","unstructured":"Terada Y, Inoue S, Tanaka Y, Kawaguchi M, Hirai K, Furuya H: The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study. Can J Anaesth 57:1089\u20131094, 20102089069110.1007\/s12630-010-9393-2"},{"key":"b14-jns152118","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"2787","DOI":"10.1097\/CCM.0b013e318186aec8","article-title":"Variation in critical care services across North America and Western Europe.","volume":"36","author":"Wunsch H,","year":"2008","unstructured":"Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EA, : Variation in critical care services across North America and Western Europe.. Crit Care Med 36:2787\u20132793, e1\u2013e9, 200810.1097\/CCM.0b013e318186aec818766102"},{"key":"b15-jns152118","series-title":"Am J Respir Crit Care Med","doi-asserted-by":"publisher","first-page":"1666","DOI":"10.1164\/rccm.201012-1961OC","article-title":"Comparison of medical admissions to intensive care units in the United States and United Kingdom","volume":"183","author":"Wunsch H,","year":"2011","unstructured":"Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM: Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med 183:1666\u20131673, 201110.1164\/rccm.201012-1961OC21471089"},{"key":"b16-jns152118","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"2782","DOI":"10.1097\/01.CCM.0000098860.52812.24","article-title":"Neurologic intensive care resource use after brain tumor surgery: an analysis of indications and alternative strategies","volume":"31","author":"Ziai WC,","year":"2003","unstructured":"Ziai WC, Varelas PN, Zeger SL, Mirski MA, Ulatowski JA: Neurologic intensive care resource use after brain tumor surgery: an analysis of indications and alternative strategies. Crit Care Med 31:2782\u20132787, 200310.1097\/01.CCM.0000098860.52812.2414668615"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/126\/6\/article-p1967.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/126\/6\/article-p1967.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/126\/6\/article-p1967.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T03:09:29Z","timestamp":1742699369000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/126\/6\/article-p1967.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8]]},"references-count":16,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2016.5.jns152118","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8]]}}}