title: Outcomes from abdominal aortic aneurysm resection: does surgical intensive care unit length of stay make a difference?
abstract: Recent studies indicate that surgical intensive care unit (SICU) length of stay (LOS) may be shortened without significantly compromising patient care. We tested the validity of that claim in patients following abdominal aortic aneurysm (AAA) resection, a group that traditionally mandated SICU care, to determine whether recent changes in care have affected outcomes. Severity of illness, utilization of SICU-specific resources, lengths of stay, and outcomes were measured in 295 consecutive AAA patients admitted to the SICU postoperatively over a 6-year period (1988-1994). Patient age ranged from 32 to 97 years (mean, 73.1 +/- 0.5) with 82 per cent males and 18 per cent females. There were 266 elective AAAs and 29 ruptured AAAs. Overall mortality was 5.8 per cent, including a 3.4 per cent mortality in elective AAA patients and 27.6 per cent mortality in the ruptured group. Patients with ruptured AAAs were 4.5 years older than were elective AAA patients, had higher severity of illness scores, and had longer SICU and hospital LOS. In the elective group, SICU LOS declined from 3.3 +/- 0.4 to 1.7 +/- 0.3 days over the study period, without a concomitant change in admission severity of illness, hospital LOS, or mortality. Severity of illness at the time of transfer from the SICU to floor care rose over 21 per cent during the study period. Over a 6-year period, SICU LOS was reduced by nearly 50 per cent in patients receiving elective AAA resections without affecting outcome, as measured by hospital LOS or mortality. Decreasing the SICU LOS was effected by transferring patients to floor care with a higher severity of illness. This change saved approximately $175,000 per year in SICU costs.
authors.affiliation: The Burns and Allen Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Cunneen
authors.forename: W H
authors.initials: WH
authors.lastname: Wagner
authors.forename: M M
authors.initials: MM
authors.lastname: Shabot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003422:Critical Care; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome