1403. NeuroICU Stay Independently Predicts Increased Length of Stay and Hospital Cost

Authors: Matthew Z. Sun, MD; Diana Babayan; Joseph Chen; Maxwell Wang; Priyanka Naik; Kara Reitz; Won Kim, MD (Los Angeles, CA)

Introduction: The neuro-intensive care unit (NICU) is traditionally used as the default initial recovery unit for nearly all elective craniotomies for brain tumor resection. Over the last five years, some neurosurgeons at our institution initiated a trial of admitting patients to the neuroscience ward for postoperative recovery for patients who were expected to have an uneventful and short admission. Methods: We retrospectively analyzed a single university hospital’s admission clinical and cost data of all adult patients who underwent elective supratentorial craniotomies for tumor resection and stayed less than 7 days in the hospital. We compared those who stayed in the ICU for 1 day during admission versus those who did not stay in the ICU. Patients undergoing shunts, ommaya, endoscopic, burr hole craniotomies, posterior fossa craniotomies and any vascular procedures were excluded. Results: 688 patients were included, with 429 patients staying in the NICU for 1 day (NICU1) and 259 not staying in the NICU (NICU0). There was no difference in University Hospital Consortium (UHC) expected length of stay (p=0.325). However, the actual length of stay for the NICU1 group was 12 hours longer than then NICU0 group (3.6 vs 3.1 days) (p < 0.0001), and the difference was still significant in multivariate analysis controlling for age, MS DRG, OR hours, insurance type, discharge disposition, and admit day. While there was no difference in the cost of surgery or OR time, the ICU1 group incurred direct hospital cost on average of $3070 per admission (multivariate analysis:p < 0.001). Clinically, there was no statistically significant difference in the rate of return to OR, ED readmission, or hospital readmission within 30 days. Conclusion: NICU stay was independently associated with increased length of stay and direct hospital cost associated with admission, without any difference in clinical outcome.