Why routine intensive care unit admission after elective open infrarenal Abdominal Aortic Aneurysm repair is no longer an evidence based practice.
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Affiliation
Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland., ryansurgeon@gmail.comIssue Date
2012-01-31T16:38:59ZMeSH
AgedAortic Aneurysm, Abdominal/*surgery
Creatinine/blood
Evidence-Based Medicine
Female
Humans
Intensive Care Units/*utilization
Male
Middle Aged
Patient Admission/*statistics & numerical data
Postoperative Complications/epidemiology
Retrospective Studies
Risk Assessment
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Surgeon. 2010 Dec;8(6):297-302. Epub 2010 Jun 9.Journal
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and IrelandDOI
10.1016/j.surge.2010.05.003PubMed ID
20950766Abstract
BACKGROUND: Elective open infrarenal Abdominal Aortic Aneurysm (AAA) repair is major surgery performed on high-risk patients. Routine ICU admission postoperatively is the current accepted standard of care. Few of these patients actually require a level of care that cannot be provided just as effectively in a surgical high dependency unit (HDU). Our aim was to determine, 'can high risk patients that will require ICU admission postoperatively be reliably identified preoperatively?'. METHODS: A retrospective analysis of all elective open infrarenal AAA repairs in our institution over a 3-year period was performed. The Estimation of Physiological Ability and Surgical Stress (E-PASS) model was used as our risk stratification tool for predicting post-operative morbidity. Renal function was also considered as a predictor of outcome, independent of the E-PASS. RESULTS: 80% (n = 16) were admitted to ICU. Only 30% (n = 6) of the total study population necessitated intensive care. There were 9 complications in 7 patients in our study. The E-PASS comprehensive risk score (CRS)/Surgical stress score (SSS) were found to be significantly associated with the presence of a complication (p = 0.009)/(p = 0.032) respectively. Serum creatinine (p = 0.013) was similarly significantly associated with the presence of a complication. CONCLUSIONS: The E-PASS model possessing increasing external validity is an effective risk stratification tool in safely deciding the appropriate level of post-operative care for elective infrarenal AAA repairs.Language
engISSN
1479-666X (Print)1479-666X (Linking)
ae974a485f413a2113503eed53cd6c53
10.1016/j.surge.2010.05.003
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