title: Clinical features and outcome of patients admitted to the intensive care unit after plastic surgical procedures: implications for cost reduction and quality of care.
abstract: Recent interest in cutting cost and improving utilization and delivery of perioperative services has prompted surgeons to identify patient populations that would benefit from care in an intensive care unit as opposed to intermediate or standard care. The purpose of this study was to evaluate patients admitted to the surgical intensive care unit (SICU) after major plastic/reconstructive surgical procedures in order to determine appropriate perioperative management strategies for these patients. We reviewed retrospectively the data from 2,805 consecutive admissions to the SICU between 1990 and 1996. Forty-two patients (1.5%) who had undergone major plastic/reconstructive procedures were identified. Outcomes (mortality, length of stay in the SICU and hospital, and the degree of organ dysfunction) were compared between this population, an illness severity-matched (Acute Physiology and Chronic Health Evaluation [APACHE]-II and APACHE III) population of patients recovering from vascular surgical procedures, and a similarly matched population of SICU patients who were randomly assigned to serve as a second control group. The hospital mortality of the plastic surgical patient population (9.5%) was significantly higher than the zero mortality of the random cohort (p < 0.05). A second analysis compared the SICU plastics group to a case-controlled group of patients who were admitted to the postanesthesia care unit (PACU) for at least 24 hours of perioperative monitoring. SICU patients had significantly higher APACHE II scores (10.9) when compared to PACU patients (7.2; p < 0.01). Based on severity of illness scoring and eventual mortality, patients admitted to our SICU after major reconstructive surgery were selected appropriately for that setting. In contrast, the patients who stayed in the PACU for perioperative monitoring did not require life-supporting therapy and, therefore, were overmonitored. Care could be provided in a specialized unit with dedicated nursing specifically trained for that purpose.
authors.affiliation: Department of Surgery, New York Hospital-Cornell Medical Center, New York 10021, USA.
authors.forename: M
authors.initials: M
authors.lastname: Talmor
authors.forename: L J
authors.initials: LJ
authors.lastname: Hydo
authors.forename: N
authors.initials: N
authors.lastname: Shaikh
authors.forename: L B
authors.initials: LB
authors.lastname: Gayle
authors.forename: L A
authors.initials: LA
authors.lastname: Hoffman
authors.forename: P S
authors.initials: PS
authors.lastname: Barie
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003363:Cost Control; D003422:Critical Care / Q000191:economics*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010343:Patient Admission / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000191:economics*; D013518:Surgery, Plastic / Q000191:economics* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome