ELECTIVE BEDSIDE SURGERY IN CRITICALLY INJURED PATIENTS IS SAFE AND COST-EFFECTIVE

Objective The success of elective minimally invasive surgery suggested that this concept could be adapted to the intensive care unit. We hyp othesized that minimally invasive surgery could be done safely and cos t-effectively at the bedside in critically injured patients. Summary B ackground Data This case series, conducted between October 1991 and Ju ne 1997 at a Level I trauma center, examined bedside dilatational trac heostomy (BDT), percutaneous endoscopic gastrostomy (PEG), and inferio r vena cava (IVC) filter placement. All procedures had been performed in the operating room (OR) before initiation of this study. Methods Al l BDTs and PEGs were performed with intravenous general anesthesia (fe ntanyl, diazepam, and pancuronium) administered by the surgical team. IVC filters were placed using local anesthesia and conscious sedation. BDTs were done using a Ciaglia set, PEGs were done using a 20 Fr Flex iflow Inverta-PEG kit, and IVC filters were placed percutaneously unde r ultrasound guidance. Cost difference (delta(cost)) was defined as th e difference in hospital cost and physician charges incurred in the OR as compared to the bedside. Results Of 16,417 trauma admissions, 379 patients (2%) underwent 472 minimally invasive procedures (272 BDTs, 1 29 PEGs, 71 IVC filters). There were four major complications (0.8%). Two patients had loss of airway requiring reintubation. Two patients h ad an intraperitoneal leak from the gastrostomy requiring operative re pair. No patient had a major complication after IVC filter placement. Total delta(cost) was $611,994. When examined independently, the delta (cost) was $324,224 for BDT, $164,088 for PEG, and $123,682 for IVC fi lter, OR use was reduced by 506 hours. Conclusions These bedside proce dures have minimal complications, eliminate the risk associated with p atient transport, reduce cost, improve OR utilization, and should be c onsidered for routine use in the general surgery population.