Impact of ICU organization and staffing on outcomes after abdominal aortic surgery

Introduction: Previous work has demonstrated an association between hospital volume and surgical expérience with operative mortality, but die relationship between ICU care and outcome is imriMr We sought to evaluate the impact of ICU organization and staffing on in-hospital mortality, total charges, tengtb-of-stay, and ICU days after abdominal aortic surgery m Maryland between 1994-1996. Methods: We obtained discharge abstracts from the Maryland Health Services Cost Review Commission on all patients who had a primary procedure for inftarenal abdominal aortic surgery from 1/94-12/96 (N = 2987). We ato sea a survey of ICU organization and staffing to the medical directors of me 46 hospitals in Maryland mat pei formed Mnmmyl aortic surgery in 1994-1996. Our primary autumn were in-hosprtal mortality, total hospital charges, hospital length-of-stty. and ICU days. We performed univariaie, bivariaie. and mulovariate analysis. We adjusted me results for demographic characteristics (age, sex, race), seventy of illness (ruptured aneurysm, urgent arlmlMinp, emergent admission), co-morbid disease (each disease in the Romano-Charlson index), hospital volume, and number of cases performed by the surgeon. Variance estimates were adjusted for clustering within hospitals. Remits: We received 39 completed questionnaires (83% response). In multivariate analysis, lade of daily ICU rounds was associated with in-hospital mortality (OR 3.0. CI 1.9-4.9). in mulävariaie analysis, independent predictors of total hosptal charges were ICU physician ""gHt prient in ICU (27% decrease) and extubating patients in the operating room (15% increase). Inlfiirndent pfftlif His of length-of-suy were parse to patient ratio < 1:2 during the evening (20% increase), ICU review of iimbidily and mortality (15% decrease), and routiner/ exftiotung patients in the operating room (11.1% increase). Independent predictors of ICU days were lack of ICU rounds (62% increase) and use of invasive bemodynamic monitors (35% increase). In adjusted unrvariaie analysis, lack of dairy ICU rounds was associated wim the following complications: cardiac arrest (OR 2.9, O 1.2-7.0). acme renal failure (OR 1.8 CI 1.2-2.6). and reinmbaboo (OR 2.0 a 1.04.1). CupciusioB; Organization and ICU staffing appears to have a significant relationship to short-torn clinical and economic outcomes after abdominal aortic surgery. We look toward designing interventions to reduce morality and hospital charges in ICU patients.