title: When the ICU is the operating room.
abstract: BACKGROUND
  The surgical intensive care unit (SICU) is increasingly used as a surrogate operating room (OR). This study seeks to characterize a Level I trauma center's operative undertakings in the SICU versus OR for trauma and emergency general surgery patients.
  
  
  METHODS
  Operative and ICU databases were queried for all operative procedures as a function of procedure type (CPT code) and location (OR, ICU) from August 2002 through June 2009. Mode of ventilation, type of anesthesia used, and adverse outcomes were recorded. Data were divided into 2002-2006 versus 2007-2009 because of MD staffing and service structure changes. Time frames were compared via Student's t-test or χ(2) as appropriate; significance for p < 0.05 (*) versus 2002-2006.
  
  
  RESULTS
  Trauma service-admitted patient volume increased from 2002-2003 (n = 1,293) to 2006-2007 (n = 1,577) and again in 2008-2009 (n = 1,825). Emergency general surgery total operative cases increased from 2002-2003 (n = 246) to 2005-2006 (n = 468). Case volume further increased in 2006-2007 (n = 767*), 2007-2008 (n = 1,071*), and 2008-2009 (n = 875*) compared with 2002-2003 or 2005-2006. Relaparotomy and temporary abdominal closure procedures were significantly increased in 2007-2008 (n = 109*) and 2008-2009 (n = 128*) versus 2002-2006 (n = 6) and 2006-2007 (n = 10). ICU cases were 11.5% of total cases (OR + ICU) spanning 2002-2006 and significantly increased to 24.3%* in 2007-2008 and 36%* in 2008-2009. Advanced ventilation was used in 15% of ICU cases in 2002-2003 and significantly increased to 40% in 2006-2007 and 78%* in 2008-2009. Neuromuscular blockade was rare; most cases (93.9%) were performed under deep sedation.
  
  
  CONCLUSIONS
  Our ICU is increasingly used for surgical procedures traditionally reserved for the OR. Advanced ventilation management may influence the choice of operative location. The ICU may be safely used as an operative location for the critically ill and injured.
  
  
  METHODS
  Epidemiologic study, level III.
authors: Department of Surgery, Section of Trauma, Yale University School of Medicine, New Haven, Connecticut 06520, USA. greta.piper@yale.edu
authors: Greta L
authors: GL
authors: Piper
authors: Linda L
authors: LL
authors: Maerz
authors: Kevin M
authors: KM
authors: Schuster
authors: Adrian A
authors: AA
authors: Maung
authors: Gina M
authors: GM
authors: Luckianow
authors: Kimberly A
authors: KA
authors: Davis
authors: Lewis J
authors: LJ
authors: Kaplan
mesh_terms: D003237:Connecticut; D016638:Critical Illness; D004630:Emergencies; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D009873:Operating Rooms / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000601:surgery*