Overnight intensive recovery: elective open aortic surgery without a routine ICU bed.
OBJECTIVE
Most patients are managed on the intensive care unit (ICU) after elective open aortic surgery. We preoperatively identify patients suitable for extubation in theatre with overnight management in theatre recovery before discharge back to the ward (overnight intensive recovery (OIR)). The safety of this was investigated.


METHODS
Retrospective case note analysis of all patients who underwent EOAS from 1998 to 2002, recording in-hospital morbidity and mortality. Physiological and operative severity score for the enUmeration of mortality and morbidity (POSSUM) data were collected prospectively.


METHODS
Patients were divided into those selected for OIR and those booked for elective ICU admission. Observed morbidity and mortality data were compared with predicted outcomes generated by Portsmouth-POSSUM and POSSUM equations.


RESULTS
Hundred and fifty-two out of 178 patients used OIR; 155 patients had abdominal aortic aneurysm (AAA) repair. The elective ICU group had significantly higher anaesthetic risk scores (ASA grade), larger AAA, greater intraoperative blood loss and longer operations. In the OIR group, ten patients (7%) needed ICU admission within 48h postoperatively. Complications occurred in 85/152, with two deaths. There was no excess morbidity or mortality in the OIR group (predicted 95% CI 83-105 and 5-17, respectively).


CONCLUSIONS
Most patients having elective open aortic surgery can be managed safely using OIR.
Callaghan
C J
CJ
Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
Lynch
A G
AG
Amin
I
I
Fazel
M
M
Lindop
M J
MJ
Gaunt
M E
ME
Varty
K
K
D000368:Aged; D000762:Anesthesia Recovery Period; D001011:Aorta / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D003422:Critical Care / Q000379:methods*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011997:Recovery Room; D012189:Retrospective Studies; D016019:Survival Analysis