Is routine use of the intensive care unit after elective infrarenal abdominal aortic aneurysm repair necessary?

Introduction: Postoperative care after infrarenal abdominal aortic aneurysm (AAA) repair has traditionally involved admission to the intensive care un it (ICU). With the advent of endovascular AAA repair, the management of ope n procedures has received increased scrutiny. We recently modified our AAA clinical pathway to include selective use of the ICU. Methods: Consecutive elective infrarenal AAA repairs performed by members o f the vascular surgery division at a university medical center from 1994 to 1999 were analyzed retrospectively with a computerized database, the Medic al Archival Retrieval System. Group I consisted of 245 patients who were tr eated in the ICU for 1 or more days, and Group II included 69 patients admi tted directly to the floor. Ruptured, symptomatic, suprarenal, endovascular , and reoperative repairs were excluded. Outcome variables were compared ov er the 6-year period. Results: Floor admissions increased over the study period with 0%, 0%, 3.3% , 16.3%, 48.6%, and 43.6% of patients admitted directly to the surgery ward from 1994 to 1999. The average ICU length of stay declined from 4.6 to 1.2 days, whereas the hospital length of stay decreased from 12.5 to 6.8 days from 1994 to 1999. The change in ICU use had no effect on death (2.4% in Gr oup I vs OX in Group II). Major and minor morbidity was comparable. Hospita l charges were significantly lower for patients in Group II. Conclusion: A policy of selective utilization of the ICU after elective inf rarenal AAA repair is safe. It can reduce resource use without a negative i mpact on the quality of care.