title: Routine postoperative intensive care monitoring is not necessary after radical cystectomy.
abstract: OBJECTIVE
  Patients undergoing radical cystectomy have historically required intensive care monitoring in the perioperative period. We examined the postoperative care of these patients since the institution of a clinical care pathway with special attention to the need for intensive care unit admission.
  
  
  METHODS
  We reviewed the records of 304 consecutive patients who underwent radical cystectomy from December 1995 to July 2000. Variables examined were the location and nature of postoperative care, American Society of Anesthesiologists score, estimated blood loss, transfusion requirement, hospital stay, perioperative minor complications, major complications, the mortality rate and urinary diversion type.
  
  
  RESULTS
  Of the 304 patients 20 (6.5%) required intensive care unit monitoring during postoperative recovery and 18 were admitted directly to the intensive care unit postoperatively. Compared with the total population those admitted to the intensive care unit had increased hospital stay (p = 0.002), higher American Society of Anesthesiologists score (p <0.001), higher transfusion requirement (p = 0.001) and shorter operative time (p = 0.02). Patients who received blood transfusion and those with major complications were more likely to need intensive care unit care (p = 0.019 and <0.001, respectively). A single patient died who did not receive intensive care unit care.
  
  
  CONCLUSIONS
  Our clinical care pathway outlines postoperative care on the regular urology floor for patients who undergo radical cystectomy. This policy has been safe and efficacious. We believe that admission to the intensive care unit should only be done in select cases.
authors.affiliation: Department of Urologic Surger, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Hassan
authors.forename: Nancy
authors.initials: N
authors.lastname: Wells
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
mesh_terms: D015897:Comorbidity; D019091:Critical Pathways; D015653:Cystectomy; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D011182:Postoperative Care; D011184:Postoperative Period; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000601:surgery*; D014547:Urinary Diversion