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 & 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 50,750.
Conclusion
The efficiency and quality of care following elective AAA surgery can be improved by provision of HDU step-down facilities without significantly increased expenditure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit.Br J Surg 1991;78:356–360
Bayley PJM, Matthews JNS, Dobson PM, Price ML, Thomas DG. In-hospital mortality from abdominal aortic surgery in Great Britain and Ireland. Vascular Anaesthesia Society Audit.Br J Surg 2001;88:687–692.
Jones HJ, Coggins R, Lafuente J, Cossart L. Value of a surgical high-dependency unit.Br J Surg. 1999; 86 (12): 1578–82.
Davies J, Tamhane R, Scholefield C, Curley P. Does the introduction of HDU reduce surgical mortality?Ann R Coll Surg Engl. 1999; 81 (5): 343–7.
Durbin CG, Kopel RF. A case-control study of patients readmitted to the intensive care unit.Crit Care Med 1993; 21: 1547–53.
Byrick RJ, Mazer CD, Caskennette GM. Closure of an intermediate care unit: impact on critical care utilisation.Chest 1993; 104: 876–81.
Boots, Lipman J. High dependency units: issues to consider in their planning.Anaesth Intensive Care 2002; 30; (3): 348–54.
Thompson FJ, Singer M. High dependency units in the UK: variable size, variable character, few in number.Postgrad Med J. 1995; 71 (834): 217–21.
Dhond G, Ridley S, Palmer M. The impact of a highdependency unit on the workload of an intensive care unit.Anaesthesia 1998; 53 (9): 841–7.
Gamil M, Fanning A. The first 24 hours after surgery. A study of complications after 2153 consecutive operations.Anaesthesia 1991; 46: 712–5.
Leeson-Payne CG, Aitkenhead AR. A prospective study to assess the demand for a high dependency unit.Anaesthesia. 1995; 50: 383–7.
Singer M, Myers S, Hall G, Cohen SL, Armstrong RF. The cost of intensive care: a comparasion of one unit between 1988 and 1991.Intensive Care Medicine 1994; 20: 542–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cleary, M., Cahill, R.A., Younis, F. et al. The impact of the establishment of a surgical high dependency unit on management of Abdominal Aortic Aneurysm. Ir J Med Sci 175, 9–12 (2006). https://doi.org/10.1007/BF03169165
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03169165