• J Trauma Acute Care Surg · Mar 2013

    Comparative Study

    When the ICU is the operating room.

    • Greta L Piper, Linda L Maerz, Kevin M Schuster, Adrian A Maung, Gina M Luckianow, Kimberly A Davis, and Lewis J Kaplan.
    • Department of Surgery, Section of Trauma, Yale University School of Medicine, New Haven, Connecticut 06520, USA. greta.piper@yale.edu
    • J Trauma Acute Care Surg. 2013 Mar 1; 74 (3): 871-5.

    BackgroundThe surgical intensive care unit (SICU) is increasingly used as a surrogate operating room (OR). This study seeks to characterize a Level I trauma center's operative undertakings in the SICU versus OR for trauma and emergency general surgery patients.MethodsOperative and ICU databases were queried for all operative procedures as a function of procedure type (CPT code) and location (OR, ICU) from August 2002 through June 2009. Mode of ventilation, type of anesthesia used, and adverse outcomes were recorded. Data were divided into 2002-2006 versus 2007-2009 because of MD staffing and service structure changes. Time frames were compared via Student's t-test or χ(2) as appropriate; significance for p < 0.05 (*) versus 2002-2006.ResultsTrauma service-admitted patient volume increased from 2002-2003 (n = 1,293) to 2006-2007 (n = 1,577) and again in 2008-2009 (n = 1,825). Emergency general surgery total operative cases increased from 2002-2003 (n = 246) to 2005-2006 (n = 468). Case volume further increased in 2006-2007 (n = 767*), 2007-2008 (n = 1,071*), and 2008-2009 (n = 875*) compared with 2002-2003 or 2005-2006. Relaparotomy and temporary abdominal closure procedures were significantly increased in 2007-2008 (n = 109*) and 2008-2009 (n = 128*) versus 2002-2006 (n = 6) and 2006-2007 (n = 10). ICU cases were 11.5% of total cases (OR + ICU) spanning 2002-2006 and significantly increased to 24.3%* in 2007-2008 and 36%* in 2008-2009. Advanced ventilation was used in 15% of ICU cases in 2002-2003 and significantly increased to 40% in 2006-2007 and 78%* in 2008-2009. Neuromuscular blockade was rare; most cases (93.9%) were performed under deep sedation.ConclusionOur ICU is increasingly used for surgical procedures traditionally reserved for the OR. Advanced ventilation management may influence the choice of operative location. The ICU may be safely used as an operative location for the critically ill and injured.Level Of EvidenceEpidemiologic study, level III.

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