H Shiels1, A N Desmond, R Parimkayala, J Cahill. 1. Department of Anaesthesia and Intensive Care Medicine, Mercy University Hospital, Cork, Ireland. hannah_shiels@yahoo.co.uk
Abstract
BACKGROUND: The potential impact of surgical service reconfiguration on intensive care unit (ICU) resources needs to be assessed. AIMS: To determine the resources required to provide post-operative ICU care to patients undergoing open abdominal aortic aneurysm (AAA) repair or endovascular aneurysm repair (EVAR) at a specialist centre in the HSE South area METHODS: For 198 patients, we calculated: (1) ICU bed-days; (2) organ support required; and (3) monetary cost of ICU care. RESULTS: In total, 82.8% (101/122) of patients undergoing open AAA repair required post-operative ICU care (52 emergency and 49 elective). Emergency cases required more ICU bed-days (median 4.2 vs. 1.9, p<0.0005) and were more likely to require ventilation (odds ratio, OR 11.7, p<0.0001), inotropes (OR 3.1, p=0.01) or enteral nutrition (OR 23.3, p<0.0001). Mean cost per patient was €3,956 for elective cases and €16,419 for emergency cases. No patient required ICU admission after EVAR (n=76). CONCLUSIONS: Open AAA surgery places significant demands on ICU resources. The planned reconfiguration of surgical services in Ireland must provide for parallel investment in ICU facilities and expertise.
BACKGROUND: The potential impact of surgical service reconfiguration on intensive care unit (ICU) resources needs to be assessed. AIMS: To determine the resources required to provide post-operative ICU care to patients undergoing open abdominal aortic aneurysm (AAA) repair or endovascular aneurysm repair (EVAR) at a specialist centre in the HSE South area METHODS: For 198 patients, we calculated: (1) ICU bed-days; (2) organ support required; and (3) monetary cost of ICU care. RESULTS: In total, 82.8% (101/122) of patients undergoing open AAA repair required post-operative ICU care (52 emergency and 49 elective). Emergency cases required more ICU bed-days (median 4.2 vs. 1.9, p<0.0005) and were more likely to require ventilation (odds ratio, OR 11.7, p<0.0001), inotropes (OR 3.1, p=0.01) or enteral nutrition (OR 23.3, p<0.0001). Mean cost per patient was €3,956 for elective cases and €16,419 for emergency cases. No patient required ICU admission after EVAR (n=76). CONCLUSIONS: Open AAA surgery places significant demands on ICU resources. The planned reconfiguration of surgical services in Ireland must provide for parallel investment in ICU facilities and expertise.
Authors: Stephen J Goodyear; Heng Yow; Mahmud Saedon; Joanna Shakespeare; Christopher E Hill; Duncan Watson; Colette Marshall; Asif Mahmood; Daniel Higman; Christopher He Imray Journal: Perioper Med (Lond) Date: 2013-05-19