Why routine intensive care unit admission after elective open infrarenal Abdominal Aortic Aneurysm repair is no longer an evidence based practice.

Hdl Handle:
http://hdl.handle.net/10147/206378
Title:
Why routine intensive care unit admission after elective open infrarenal Abdominal Aortic Aneurysm repair is no longer an evidence based practice.
Authors:
Ryan, David; McGreal, Gerard
Affiliation:
Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland., ryansurgeon@gmail.com
Citation:
Surgeon. 2010 Dec;8(6):297-302. Epub 2010 Jun 9.
Journal:
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/206378
DOI:
10.1016/j.surge.2010.05.003
PubMed ID:
20950766
Abstract:
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:
eng
MeSH:
Aged; Aortic 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
ISSN:
1479-666X (Print); 1479-666X (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorRyan, Daviden_GB
dc.contributor.authorMcGreal, Gerarden_GB
dc.date.accessioned2012-01-31T16:38:59Z-
dc.date.available2012-01-31T16:38:59Z-
dc.date.issued2012-01-31T16:38:59Z-
dc.identifier.citationSurgeon. 2010 Dec;8(6):297-302. Epub 2010 Jun 9.en_GB
dc.identifier.issn1479-666X (Print)en_GB
dc.identifier.issn1479-666X (Linking)en_GB
dc.identifier.pmid20950766en_GB
dc.identifier.doi10.1016/j.surge.2010.05.003en_GB
dc.identifier.urihttp://hdl.handle.net/10147/206378-
dc.description.abstractBACKGROUND: 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.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAortic Aneurysm, Abdominal/*surgeryen_GB
dc.subject.meshCreatinine/blooden_GB
dc.subject.meshEvidence-Based Medicineen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIntensive Care Units/*utilizationen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPatient Admission/*statistics & numerical dataen_GB
dc.subject.meshPostoperative Complications/epidemiologyen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshRisk Assessmenten_GB
dc.titleWhy routine intensive care unit admission after elective open infrarenal Abdominal Aortic Aneurysm repair is no longer an evidence based practice.en_GB
dc.contributor.departmentDepartment of Vascular Surgery, Mercy University Hospital, Cork, Ireland., ryansurgeon@gmail.comen_GB
dc.identifier.journalThe surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Irelanden_GB
dc.description.provinceMunster-

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