Overnight Intensive Recovery: Elective Open Aortic Surgery Without a Routine ICU Bed

Callaghan, Chris; Lynch, Andy G.; Amin, Irum; Fazel, Maisam; Lindop, M. J.; Gaunt, Michael E.; Varty, K.

doi:10.1016/j.ejvs.2005.03.004

Cited by 23 publications

(26 citation statements)

References 16 publications

(20 reference statements)

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“…17 Moreover, a higher ASA score is associated with more surgical and nonsurgical complications in patients undergoing craniotomy for brain tumor 18 and it has been recommended to perform total removal of intracranial meningiomas even in old patients only if the preoperative ASA score is 1 or 2. First, more patients in the group of postponed extubation had a higher ASA status score.…”

Section: Discussionmentioning

confidence: 99%

Successful Extubation in the Operating Room After Infratentorial Craniotomy

Cata

Saager

Kurz

et al. 2011

Journal of Neurosurgical Anesthesiology

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Section: Discussionmentioning

confidence: 99%

Successful Extubation in the Operating Room After Infratentorial Craniotomy

Cata

Saager

Kurz

et al. 2011

Journal of Neurosurgical Anesthesiology

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“…One recent study showed that the majority of such patients could be managed without ICU admission, although "overnight intensive recovery" in the postoperative care unit was provided. 404 Another group reported selective ICU admission after four hours of observation in the PACU for patients eligible for "fast track" OSR. Although mean ICU stay in 30 patients was 0.87 Ϯ 0.10 days, the percentage of patients sent directly to the floor was not reported.…”

Section: Maintenance Of Body Temperaturementioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

615

520

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DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

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“…Upon review of these cases, the authors were unable to discern why individual patients were preemptively placed in the ICU or an intermediate care unit [17]. Other authors have demonstrated a reduced mortality with no worsening morbidities using a strategy of up to 24-hour management in the operative recovery room of preselected patients after elective abdominal aortic surgery [21][22][23]. Moreover, a propensity case matched retrospective review of 104 pairs of elective neurosurgical patients with American Society of Anaesthesiologists Status I or II failed to demonstrate a difference in Glasgow Outcome Score, mortality, or complication rates between those assigned to ICU care versus neurosurgical ward care postoperatively [24].…”

Section: Discussionmentioning

confidence: 99%