This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Enhanced critical care improves the mortality rate following elective aneurysm repair. BJS 2001; 88: 615-616.
Published: 6th December 2002
Authors: M. Anderton, G. Treharne, N. London, R. Naylor, P. R. Bell, M. M. Thompson et al.
Background
In a previous study performed at this centre (1994–1997) to document the impact of instituting an endovascular programme, the mortality rate for elective infrarenal aneurysm repair was unacceptable (16 per cent). In an attempt to reduce this complication rate, two fundamental changes in practice were instituted. First, patients were selected and counselled for operation on the basis of a physiological scoring system, POSSUM (Physiological and Operative Surgical Score for the enUmeration of Mortality and morbidity). Second, patients were admitted to the critical care unit for at least 3 days after operation, before discharge to the ward. The aim of the study was to audit the result of these changes.
Method
Data were collected prospectively for all patients admitted for elective aneurysm repair between November 1998 and January 2000. POSSUM score, postoperative mortality and morbidity, and intensive care unit (ITU) or high dependency unit stay were compared between historical controls (1994–1997) and operations performed after the change in practice.
Results
The results are tabulated below as median values. χ2and Mann–Whitney U tests
Conclusion
These data demonstrate that defined changes in the perioperative management of patients undergoing elective aneurysm surgery may favourably affect mortality. As there was no difference in POSSUM scores between the two groups, it is likely that the improved outcome reflects more intensive postoperative care. © 2001 British Journal of Surgery Society Ltd
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