title: The impact of the establishment of a surgical high dependency unit on management of abdominal aortic aneurysm.
abstract: BACKGROUND
  Our ability to maintain satisfactory levels of outcome after elective abdominal aortic aneurysm (AAA) surgery is increasingly strained by rising levels of co-morbidity in the presenting population. In this study we present a comparative outcome analysis of patients undergoing elective AAA surgery 18 months before and after the establishment of a surgical high dependency unit (HDU).
  
  
  METHODS
  The preoperative status (ASA and POSSUM scores), operative factors and postoperative outcomes as well as duration of stay were calculated for 104 patients undergoing elective AAA repair (57 prior to the HDU opening and 47 patients afterwards).
  
  
  RESULTS
  Patients undergoing surgery in the latter period had significantly higher ASA (2.5 +/- 0.06 versus 2.7 +/- 0.7; p = 0.007), overall POSSUM (33.2 +/- 0.5 versus 35.5 +/- 0.8; p = 0.02) and physiological POSSUM (16.3 +/- 0.3 versus 15.5 +/- 0.2; p = 0.048) scores than those operated on prior to establishment of the HDU (data are mean +/- SEM; 2-tailed p-score). The two groups had similar total lengths of hospital stay (518 versus 534 days). However, following establishment of the HDU patients occupied fewer ICU bed days (110 versus 181). This resulted in a saving of Euro 50,750.
  
  
  CONCLUSIONS
  The efficiency and quality of care following elective AAA surgery can be improved by provision of HDU step-down facilities without significantly increased expenditure.
authors.affiliation: Dept of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin 4.
authors.forename: M
authors.initials: M
authors.lastname: Cleary
authors.forename: R A
authors.initials: RA
authors.lastname: Cahill
authors.forename: F
authors.initials: F
authors.lastname: Younis
authors.forename: S J
authors.initials: SJ
authors.lastname: Sheehan
authors.forename: D
authors.initials: D
authors.lastname: Mehigan
authors.forename: M C
authors.initials: MC
authors.lastname: Barry
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D007902:Length of Stay / Q000191:economics*; D008297:Male; D011182:Postoperative Care / Q000191:economics; D011383:Progressive Patient Care / Q000191:economics