Assessment of the time-dependent need for stay in a high dependency unit (HDU) after major surgery by using data from an anesthesia information management system

Abstract

Admittance to a high dependency unit (HDU) is expensive. Patients who receive surgical treatment with 'low anterior resection of the rectum' (LAR) or 'abdominoperineal resection of the rectum' (APR) at our hospital are routinely treated in an HDU the first 16-24 h of the postoperative (PO) period. The aim of this study was to describe the extent of HDU-specific interventions given. We included patients treated with LAR or APR at the St. Olav University Hospital (Trondheim, Norway) over a 1-year period. Physiologic data and HDU-interventions recorded during the PO-period were obtained from the anesthesia information management system (AIMS). HDU-specific interventions were defined as the need for respiratory support, fluid replacement therapy >500 ml/h, vasoactive medications, or a need for high dose opioids (morphine >7.5 mg/h i.v.). Sixty-two patients were included. Most patients needed HDU-specific interventions during the first 6 h of the PO period. After this, one-third of the patients needed one or more of the HDU-specific interventions for shorter periods of time. Another one-third of the patients had a need for HDU-specific therapies for more than ten consecutive hours, primarily an infusion of nor-epinephrine. Most patients treated with LAR or APR was in need of an HDU-specific intervention during the first 6 h of the PO-period, with a marked decline after this time period. The applied methodology, using an AIMS, demonstrates that there is great variability in individual patients' postoperative needs after major surgery, and that these needs are dynamic in their nature.

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