Opening of a new postanesthesia care unit: impact on critical care utilization and complications following major vascular and thoracic surgery

Abstract

Study objectives To assess the impact of a new postanesthesia care unit (PACU) on intensive care unit (ICU) utilization, hospital length of stay, and complications following major noncardiac surgery. Design Observational study. Setting University hospital. Patients and measurements From 1992 to 1999, 915 patients underwent either abdominal aortic reconstruction (n = 448) or lung resection for cancer (n = 467). Demographic, clinical, surgical, and anesthetic data, as well as perioperative complications, were abstracted from two institutional databases. Interventions Patients were divided in two study periods, before and after the opening of a new PACU (period 1992–1995 and period 1996–1999). Main results Utilization of ICU decreased from 35% to 16% for vascular patients and from 57% to less than 4% for thoracic patients during the second period. Readmission to the ICU, perioperative mortality, and respiratory complications were comparable between the two periods. Patients with congestive heart failure, chronic obstructive pulmonary disease, or renal insufficiency were more likely to be admitted to the ICU than the PACU. Following vascular surgery the frequency of cardiac complications decreased from 10.6% in 1992–1995 to 5.2% in 1996–1999 ( p < 0.005), as well as the need for postoperative mechanical ventilation (25% vs. 12%; P < 0.05). Conclusions Increased availability of PACU beds resulted in reduced utilization of ICU resources without compromising patient care after major noncardiac surgery.