ORIGINAL ARTICLES   

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

Copyright © 2003 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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.