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Objectives. Most patients are managed on the intensive care unit (ICU) after elective open aortic surgery. We preoperatively identify patients suitable for extubation in theatre with overnight management in theatre recovery before discharge back to the ward (overnight intensive recovery (OIR)). The safety of this was investigated. Design. Retrospective case note analysis of all patients who underwent EOAS from 1998 to 2002, recording in-hospital morbidity and mortality. Physiological and operative severity score for the enUmeration of mortality and morbidity (POSSUM) data were collected prospectively. Methods. Patients were divided into those selected for OIR and those booked for elective ICU admission. Observed morbidity and mortality data were compared with predicted outcomes generated by Portsmouth-POSSUM and POSSUM equations.Results. Hundred and fifty-two out of 178 patients used OIR; 155 patients had abdominal aortic aneurysm (AAA) repair. The elective ICU group had significantly higher anaesthetic risk scores (ASA grade), larger AAA, greater intraoperative blood loss and longer operations. In the OIR group, ten patients (7%) needed ICU admission within 48 h postoperatively. Complications occurred in 85/152, with two deaths. There was no excess morbidity or mortality in the OIR group (predicted 95% CI 83-105 and 5-17, respectively). Conclusion. Most patients having elective open aortic surgery can be managed safely using OIR.

INTRODUCTION Intestinal intubation with a Jones' tube has been suggested to reduce the incidence of recurrent adhesive bstruction. This paper describes our experience of this technique. PATIENTS AND METHODS A retrospective case-note review was performed on 68 patients admitted to a teaching hospital who re identified as having had the Jones' intestinal tube placed over an 11-year period from 1980 to 1991, with a follow-up to 2003. The indication for placement and outcome following placement of the tube were documented with particular reference to recurrence of adhesive small bowel obstruction. RESULTS Data on 63 patients were available. Of these, 7 had the Jones' tube placed prophylactically after pouch surgery and re thus excluded from the main study. Of the remaining 56 patients, all had the Jones' tube placed for recurrent adhesive small bowel obstruction with a median follow-up of 92 months, representing 353 patient-years. In 51 patients, the Jones' tube was placed during emergency surgery, while five others had it placed electively. A total of 1.7 cases of adhesive small bowel obstruction per 100 years of patient follow-up were identified following use of the Jones' tube compared to 12.9 cases per 100 patient-years prior to the use of the Jones' tube. CONCLUSION Intestinal intubation with a Jones' tube is a safe and effective method of preventing recurrent adhesive obstruction.

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