title: Opening of a new postanesthesia care unit: impact on critical care utilization and complications following major vascular and thoracic surgery.
abstract: OBJECTIVE
  To assess the impact of a new postanesthesia care unit (PACU) on intensive care unit (ICU) utilization, hospital length of stay, and complications following major noncardiac surgery.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  From 1992 to 1999, 915 patients underwent either abdominal aortic reconstruction (n = 448) or lung resection for cancer (n = 467). Demographic, clinical, surgical, and anesthetic data, as well as perioperative complications, were abstracted from two institutional databases.
  
  
  METHODS
  Patients were divided in two study periods, before and after the opening of a new PACU (period 1992-1995 and period 1996-1999).
  
  
  RESULTS
  Utilization of ICU decreased from 35% to 16% for vascular patients and from 57% to less than 4% for thoracic patients during the second period. Readmission to the ICU, perioperative mortality, and respiratory complications were comparable between the two periods. Patients with congestive heart failure, chronic obstructive pulmonary disease, or renal insufficiency were more likely to be admitted to the ICU than the PACU. Following vascular surgery the frequency of cardiac complications decreased from 10.6% in 1992-1995 to 5.2% in 1996-1999 (p < 0.005), as well as the need for postoperative mechanical ventilation (25% vs. 12%; P < 0.05).
  
  
  CONCLUSIONS
  Increased availability of PACU beds resulted in reduced utilization of ICU resources without compromising patient care after major noncardiac surgery.
authors.affiliation: Department of Anesthesiology, Pharmacology and Surgical Intensive Care, Clinic of Cardiovascular Surgery, and Division of Thoracic Surgery, University Hospital, Geneva, Switzerland.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Schweizer
authors.forename: Gregory
authors.initials: G
authors.lastname: Khatchatourian
authors.forename: Laurent
authors.initials: L
authors.lastname: Höhn
authors.forename: Anastase
authors.initials: A
authors.lastname: Spiliopoulos
authors.forename: Jacques
authors.initials: J
authors.lastname: Romand
authors.forename: Marc
authors.initials: M
authors.lastname: Licker
mesh_terms: D000368:Aged; D000762:Anesthesia Recovery Period; D003422:Critical Care; D006801:Humans; D007362:Intensive Care Units; D016017:Odds Ratio; D016528:Postanesthesia Nursing; D011183:Postoperative Complications / Q000517:prevention & control*; D011997:Recovery Room / Q000706:statistics & numerical data*; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality