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CURRENT ISSUEINTERNATIONAL ANGIOLOGY

A Journal on Angiology


Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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ORIGINAL ARTICLES  


International Angiology 2003 September;22(3):308-16

language: English

Selective use of the intensive care unit after elective infrarenal abdominal aortic aneurysm repair

Bastounis E., Filis K., Georgopoulos S., Bakoyannis C., Xeromeritis N., Papalambros E.

Divi­sion of Vas­cu­lar Sur­gery, First Depart­ment of Sur­gery, Uni­ver­sity of Ath­ens Med­i­cal ­School, Ath­ens, ­Greece


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Aim. Abdom­i­nal aor­tic aneu­rysm (AAA) ­repair has tra­di­tion­al­ly ­involved admis­sion to the inten­sive care unit (ICU). This paper ­reports on an expe­ri­ence of using pre­op­er­a­tive med­i­cal cri­te­ria and a list of intra­op­er­a­tive fac­tors for selec­tive use of the ICU. These cri­te­ria were eval­u­at­ed in rela­tion to their ­impact on the safe­ty and short term ­results after open AAA ­repair.
Meth­ods. All elec­tive open infra­ren­al AAA ­repairs dur­ing a 9 year peri­od (1994-2003), fol­low­ing a spe­cif­ic algo­rithm ­towards selec­tive use of the ICU, were ret­ro­spec­tive­ly eval­u­at­ed. ­Patients were clin­i­cal­ly eval­u­at­ed, ­before the oper­a­tive pro­ce­dures, and divid­ed into cat­e­go­ries accord­ing to their med­i­cal risk (car­diac and pul­mo­nary stat­us). ­Patients with an ejec­tion frac­tion <30% and a FVC or FEV1 <50% of the pre­dict­ed value were trans­ferred imme­di­ate­ly from the oper­at­ing room to the ICU. A list of intra­op­er­a­tive fac­tors: 1) pro­longed oper­a­tive time; 2) pro­longed aor­tic clamp­ing time; 3) suprar­en­al clamp­ing; 4) quan­tity of blood trans­fu­sion; 5) intra­op­er­a­tive acute renal fail­ure; 6) intra­op­er­a­tive hemo­dy­nam­ic instabil­ity; 7) intra­op­er­a­tive car­diac dys­func­tion were also con­sid­ered cri­te­ria for trans­fer from the oper­at­ing room to the ICU. ­Patients who did not meet any of the above cri­te­ria were extu­bat­ed and trans­ferred to the sur­gi­cal floor.
­Results. Elec­tive AAA ­repair was per­formed on 602 ­patients, among whom, 551 (91.5%) were extu­bat­ed in the oper­at­ing room and there­af­ter treat­ed in the sur­gi­cal floor and 51 (8.5%) were trans­ferred from the oper­at­ing room to the ICU. How­ev­er, later trans­fer from the floor to the ICU was ­required in 7 more ­patients (1.1%), increas­ing the total per­cent­age of ­patients treat­ed in the ICU to 9.6%. (51 ­patients initial­ly and 7 later on). The total post­op­er­a­tive 30 days mor­tal­ity rate was 0.7% (4 ­patients) and the mor­bid­ity rate was 18.8% in this ­series. The mean ­length of in-hos­pi­tal stay was 9.9 days and the mean ICU ­length of stay was 4.2 days.
Con­clu­sion. Elec­tive AAA ­repair with selec­tive use of the ICU can be a con­sid­er­able safe pol­i­cy in a sin­gle high vol­ume hos­pi­tal. It can ­reduce ­resource use with­out a neg­a­tive ­impact on the qual­ity of care.

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