title: The effectiveness of high dependency unit in the management of high risk thoracic surgical cases.
abstract: OBJECTIVE
  To assess the effectiveness of high dependency unit (HDU) in the management of high-risk thoracic surgical cases at a single dedicated thoracic surgical unit.
  
  
  BACKGROUND
  There is a strong drive to improve postoperative management in a cost-effective way. The number of high-risk thoracic surgical procedures undertaken is increasing rapidly. The HDU can be an effective weapon in the armoury of thoracic surgeons to treat these patients effectively without the need for managing in the extreme environment of expensive intensive care beds.
  
  
  METHODS
  Patients who had undergone lobectomy, pneumonectomy and oesophagectomy were included in the study, as they formed the bulk of the high risk thoracic surgical procedures undertaken by our unit. All data were collected retrospectively from case notes and computerised patient tracking system, for the period between April 2000 and March 2001.
  
  
  RESULTS
  One hundred and ninety-one lobectomies (174 for malignancy), 86 pneumonectomies and 50 oesophagectomies were performed during the time period of the study. Of these, 189 (99%) lobectomies, 82 (95%) pneumonectomies and 47 (94%) oesophagectomies were electively admitted to HDU. The mean HDU stay was 21.8 h. Operation discharge time was 7.3 days for lung resections and 9.1 days for oesophagectomy. The overall 30-day mortality was 1.9% for lobectomy, 11% for pneumonectomy and 2% for oesophagectomy. Two oesophagectomies, one lobectomy and three pneumonectomies had to be transferred from HDU to ITU for either mechanical ventilation or more invasive monitoring. Four pneumonectomies, two lobectomies and two oesophagectomies had to be readmitted to HDU with respiratory failure or cardiac instability. Of all the readmitted patients, one pneumonectomy and one lobectomy died. The causes of death were myocardial infarction, pulmonary embolism, adult respiratory distress syndrome and septicaemia.
  
  
  CONCLUSIONS
  The above results clearly demonstrate that a well-equipped and properly manned HDU can greatly facilitate management of high-risk cases with favourable outcome. It provides excellent pain control facilities, detects complications early and avoids unnecessary ITU admissions. It also provides an excellent training opportunity for both medical and nursing staff.
authors.affiliation: Birmingham Heartlands Hospital, Bordsley Green East, Birmingham B9 5SS, UK. shilajitghosh@hotmail.com
authors.forename: Shilajit
authors.initials: S
authors.lastname: Ghosh
authors.forename: Richard S
authors.initials: RS
authors.lastname: Steyn
authors.forename: Joseph F K
authors.initials: JF
authors.lastname: Marzouk
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Collins
authors.forename: Palababu B
authors.initials: PB
authors.lastname: Rajesh
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000458:organization & administration*; D004739:England; D004935:Esophageal Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000191:economics; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000191:economics; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000191:economics