Predictors of Prolonged Intensive Care Unit Stay After Major Neurosurgical Procedures

Abstract

Background: Major neurosurgical procedures often require postoperative intensive care unit (ICU) admission for neurological monitoring and organ support. Prolonged ICU stay is associated with increased morbidity, healthcare costs, and limited ICU bed availability. Identifying factors associated with extended ICU admission may improve perioperative planning and optimize resource utilization.
Objective: To determine the clinical and perioperative predictors of prolonged ICU stay among patients undergoing major neurosurgical procedures.
Methods: A retrospective study was conducted on 100 patients who underwent major neurosurgical procedures at a tertiary care hospital between January 2024 and June 2024. Demographic, clinical, operative, and postoperative data were retrieved from medical records. Prolonged ICU stay was defined as an admission lasting more than 72 hours. Variables including age, sex, Glasgow Coma Scale (GCS), American Society of Anesthesiologists (ASA) status, emergency surgery, operative duration, intraoperative blood loss, postoperative mechanical ventilation, and complications were analyzed using univariate and multivariate logistic regression. Statistical analysis was performed using SPSS version 27.0, with a p-value <0.05 considered statistically significant.
Results: Of the 100 patients, 58% were male, and 42% were female, with a mean age of 49.8 ± 15.6 years. Prolonged ICU stay occurred in 36 patients (36%). Patients with prolonged ICU stay were significantly older than those with shorter stays (56.3 ± 14.2 vs. 46.1 ± 15.3 years; p=0.003). Emergency surgery (61.1% vs. 31.3%; p=0.006), preoperative GCS ≤8 (50.0% vs. 18.8%; p=0.001), operative duration >4 hours (p=0.012), blood loss >500 mL (p=0.021), postoperative mechanical ventilation >24 hours (p<0.001), and postoperative complications (p=0.004) were significantly associated with prolonged ICU stay. Multivariate analysis identified postoperative mechanical ventilation (adjusted OR=4.72, 95% CI: 2.01–11.08; p<0.001), low preoperative GCS (adjusted OR=3.15, 95% CI: 1.34–7.42; p=0.008), and advanced age (adjusted OR=1.04, 95% CI: 1.01–1.08; p=0.018) as independent predictors.
Conclusion: Advanced age, poor preoperative neurological status, prolonged postoperative mechanical ventilation, emergency surgery, increased operative duration, and postoperative complications independently predicted prolonged ICU stay following major neurosurgical procedures. Early recognition of these risk factors may facilitate risk stratification, optimize ICU resource allocation, and improve postoperative outcomes.