OUTCOMES FROM ABDOMINAL AORTIC-ANEURYSM RESECTION - DOES SURGICAL INTENSIVE-CARE UNIT LENGTH OF STAY MAKE A DIFFERENCE

Recent studies indicate that surgical intensive care unit (SICU) lengt h of stay (LOS) may be shortened without significantly compromising pa tient care. We tested the validity of that claim in patients following abdominal aortic aneurysm (AAA) resection, a group that traditionally mandated SICU care, to determine whether recent changes in care have affected outcomes. Severity of illness, utilization of SICU-specific r esources, lengths of stay, and outcomes were measured in 295 consecuti ve AAA patients admitted to the SICU postoperatively over a 6-year per iod (1988-1994). Patient age ranged from 32 to 97 years (mean, 73.1 +/ - 0.5) with 82 per cent males and 18 per cent females. There were 266 elective AAAs and 29 ruptured AAAs. Overall mortality was 5.8 per cent , including a 3.4 per cent mortality in elective AAA patients and 27.6 per cent mortality in the ruptured group. Patients with ruptured AAAs were 4.5 years older than were elective AAA patients, had higher seve rity of illness scores, and had longer SICU and hospital LOS. In the e lective group, SICU LOS declined from 3.3 +/- 0.4 to 1.7 +/- 0.3 days over the study period, without a concomitant change in admission sever ity of illness, hospital LOS, or mortality. Severity of illness at the time of transfer from the SICU to floor care rose over 21 per cent du ring the study period. Over a 6-year period, SICU LOS was reduced by n early 50 per cent in patients receiving elective AAA resections withou t affecting outcome, as measured by hospital LOS or mortality. Decreas ing the SICU LOS was effected by transferring patients to floor care w ith a higher severity of illness. This change saved approximately $175 ,000 per year in SICU costs.