SELECTIVE USE OF THE INTENSIVE-CARE UNIT AFTER NONAORTIC ARTERIAL-SURGERY

Purpose: The purpose of this study was to determine whether the instit ution of a clinical protocol combining 6 hours of recovery room observ ation and guidelines for intensive care unit (ICU) admission would all ow selected patients to be safely transferred directly to a surgical f loor after nonaortic arterial reconstruction. Methods: After a clinica l pathway was formed, 134 consecutive patients undergoing 154 nonaorti c arterial operations were prospectively enrolled in this study. Patie nts requiring ICU care and the responsible factors were identified. Co mparisons of risk factors and demographics were made between. those pa tients who did and did not require ICU care. Results: Twelve (7.8%) pa tients spent a total of 27 days in the ICU (range 1 to 11 days). As pe r our guidelines four patients were transferred to the ICU for invasiv e monitoring, and four were sent to the ICU because of refractory hemo dynamic instability or arrhythmia in the postanesthetic recovery room. An additional four patients were transferred to the ICU after having been on the surgical floor for 24 to 72 hours because of the following perioperative complications: prolonged chest pain (one), pneumonia (o ne), heart failure (one), and graft occlusion requiring a urokinase in fusion. Patients admitted to the ICU were more likely to have heart di sease (p = 0.02) and to have had an operation other than carotid endar terectomy (p = 0.04) than those who were not. The 30-day mortality rat e was 1.4%. Conclusions: The implementation of a clinical protocol sim ilar to the one used in this study will allow many patients undergoing nonaortic vascular surgery to avoid the use of the ICU. This approach will conserve hospital and financial resources without adversely affe cting patient morbidity and mortality rates.