Cunneen S A, Wagner W H, Shabot M M
The Burns and Allen Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Am Surg. 1998 Feb;64(2):196-9.
Recent studies indicate that surgical intensive care unit (SICU) length of stay (LOS) may be shortened without significantly compromising patient 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 resources, lengths of stay, and outcomes were measured in 295 consecutive AAA patients admitted to the SICU postoperatively over a 6-year period (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 severity of illness scores, and had longer SICU and hospital LOS. In the elective 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 severity 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 during the study period. Over a 6-year period, SICU LOS was reduced by nearly 50 per cent in patients receiving elective AAA resections without affecting outcome, as measured by hospital LOS or mortality. Decreasing the SICU LOS was effected by transferring patients to floor care with a higher severity of illness. This change saved approximately $175,000 per year in SICU costs.
近期研究表明，手术重症监护病房（SICU）的住院时间（LOS）可能会缩短，而不会对患者护理造成显著影响。我们在腹主动脉瘤（AAA）切除术后的患者中验证了这一说法的有效性，该组患者传统上需要在SICU接受护理，以确定近期护理的变化是否影响了治疗结果。在6年期间（1988 - 1994年），对295例连续入住SICU的AAA术后患者进行了疾病严重程度、SICU特定资源的利用情况、住院时间和治疗结果的测量。患者年龄在32岁至97岁之间（平均73.1 +/- 0.5岁），男性占82%，女性占18%。有266例择期AAA和29例破裂性AAA。总体死亡率为5.8%，其中择期AAA患者的死亡率为3.4%，破裂组的死亡率为27.6%。破裂性AAA患者比择期AAA患者大4.5岁，疾病严重程度评分更高，SICU和医院住院时间更长。在择期组中，在研究期间，SICU住院时间从3.3 +/- 0.4天降至1.7 +/- 0.3天，而入院时的疾病严重程度、医院住院时间或死亡率没有相应变化。在研究期间，从SICU转至普通病房护理时的疾病严重程度上升了21%以上。在6年期间，接受择期AAA切除术的患者的SICU住院时间减少了近50%，而以医院住院时间或死亡率衡量的治疗结果并未受到影响。通过将疾病严重程度更高的患者转至普通病房护理来缩短SICU住院时间。这一变化每年节省了约17.5万美元的SICU成本。
