ICU PROTOCOL MAY AFFECT THE OUTCOME OF NON-ELECTIVE ABDOMINAL AORTIC-ANEURYSM REPAIR

Objectives: to compare the outcome of patients undergoing non-elective abdominal aortic aneurysm repair at two hospitals under the care of a single vascular surgeon. Design: prospective and retrospective audit of 6 years of emergency and urgent infrarenal abdominal aortic aneurys m surgery. Setting: Lewisham and North Southwark Health Authority. Sub jects: one hundred and forty-five patients who underwent emergency (46 ) or urgent (99) repair of an abdominal aortic aneurysm. Primary outco me measure: hospital mortality. Secondary outcome measures: acute rena l failure, intensive care and hospital length of stay distal ischaemia and return to theatre. Results: mortality was higher at hospital 2 th an hospital 1 (28% vs. 9%, p = 0.0068). There was no significant diffe rence in age, sex, cardiac history, hypertension, diabetes, smoking, r enal impairment (all p>0.05). There was no difference in operation tim e, blood loss and base excess at the end of surgery between the two gr oups (all p>0.05). APACHE II scores on admission to ICU were similar i n hospital 1 and hospital 2 (median 16 vs. 14, p>0.03). Pulmonary arte ry catheters were placed in 18% of patients at hospital 1 compared wit h 96% at hospital 2. Patients at hospital 2 received more crystalloid (median 2990 vs. 2300 ml divided by, more colloid (median 4775 vs. 150 0 ml), and more inotropes (median 1 vs. 0) than those at hospital 1 in their first 24 h on ICU (all p<0.001). The volume of urine passed in the first 24 h was similar (median 2410 vs. 2000 ml, p = 0.12) yet the incidence of acute renal failure was higher at hospital 2 compared wi th hospital 1 (30% vs. 6%, p = 0.001). ICU length of stay of survivors was longer at hospital 2 (median 3 vs. 2 days, p = 0.0018) as was hos pital length of stay (median 17.5 vs. 12 days, p = 0.0002). Conclusion s: the outcome at both hospitals is at least as good as other reported series, but it is interesting to note that the hospital which used le ss pulmonary artery catheters and less intervention (in the form of co lloid and inotropes) showed a reduced mortality. These data may be imp ortant is assessing the different therapeutic strategies employed post operatively in the ICU.