Is intensive care necessary after elective abdominal aortic aneurysm repair?

To review morbidity and mortality of patients undergoing elective, open repair of infra-renal abdominal aortic aneurysms and were admitted postoperatively to a surgical stepdown unit rather than routinely to the intensive care unit (ICU), we carried out a retrospective review.

All patients undergoing this type of repair in our centre, a division of vascular surgery in a tertiary-care teaching hospital in Ontario, over a 27-month period were reviewed. A consecutive 230 patients who underwent aneurysm repair from September 1999 through November 2001 were routinely admitted to a surgical stepdown unit postoperatively, with only a minority of patients requiring admission to ICU. We reviewed the rate of initial ICU admission and that of subsequent ICU admission after stepdown-unit admission. We also assessed morbidity, mortality and length of hospital stay for patients admitted to ICU as well as those admitted to the stepdown unit.

ICU admission was avoided in 204 (89%) of these patients. The remaining 26 patients (11%) required ICU admission at some point during their hospital stay. Only 3 patients (1%) originally admitted to the stepdown unit subsequently required postoperative admission to ICU.

Our experience demonstrates that proper preoperative assessment and selection allows the majority of elective infra-renal aneurysm repairs to be safely cared for postoperatively in a stepdown unit, and that subsequent ICU admissions are rare.