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Intensive care is cost-effective in carotid endarterectomy
S D Ross1, C G Tribble, P E Parrino
1Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Insights
Routine intensive care unit (ICU) admission after carotid endarterectomy ensures safety and avoids uncertain preoperative planning. Most patients do not require interventions, allowing for potential cost reductions by shortening ICU stays if no complications arise within 12 hours.
Area of Science:
- Vascular Surgery
- Critical Care Medicine
- Health Services Research
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Postoperative intensive care unit (ICU) utilization and associated costs are significant considerations.
- Predictors of ICU need and adverse outcomes after this surgery require further analysis.
Purpose of the Study:
- To analyze the utilization, cost, and predictors of intensive care unit (ICU) services following carotid endarterectomy.
- To evaluate the safety and cost-effectiveness of routine postoperative ICU admission.
- To identify factors that may predict the need for ICU interventions or adverse outcomes.
Main Methods:
- Retrospective review of medical records for patients undergoing isolated carotid endarterectomy.
- Analysis of 91 procedures performed over a 12-month period at a university hospital.
- Assessment of ICU interventions, complications, and patient outcomes.
Main Results:
- 71.4% of patients required ICU interventions, primarily for antihypertensive therapy.
- Low rates of major adverse events: 1.1% non-fatal stroke, 1.1% non-fatal myocardial infarction.
- No preoperative factors predicted significant risk for complications; no reliable predictors for ICU need or adverse outcomes were identified.
Conclusions:
- Routine ICU admission after carotid endarterectomy supports high safety standards and simplifies preoperative planning.
- The current practice avoids the uncertainty and potential costs of recovery room stays for determining ICU needs.
- Potential cost reductions are possible by decreasing ICU length of stay for uncomplicated cases after an initial 12-hour observation period.
Abstract:
The purpose of this study was to analyze the utilization, cost profile, and predictors of intensive care unit (ICU) services after carotid endarterectomy. A retrospective medical record review of all patients undergoing isolated carotid endarterectomy by a vascular surgery service at one university hospital during a 12-month period was performed. Eighty-four patients undergoing 91 carotid endarterectomies were identified for review. All carotid endarterectomy patients at the authors' institution were routinely admitted to an ICU postoperatively. Sixty-five of the 91 patients (71.4%) required ICU interventions, the majority of which were intravenous antihypertensive therapy. There were no deaths in the group. There was one non-fatal stroke (1.1%), and one non-fatal myocardial infarction (1.1%). There were three reoperations (3.3%): two for hematoma and one for a change in neurological status. One patient required reintubation. Five of the six major adverse events after carotid endarterectomy occurred within 12 hours postoperatively. No preoperative factors predicted a significant risk for complications following carotid endarterectomy. There is no reliable predictor that carotid endarterectomy patients will require postoperative interventions or develop adverse outcomes. Mandatory intensive care immediately after carotid endarterectomy upholds high safety standards, avoids the uncertainty of preoperative ICU planning, and avoids the high cost of a recovery room stay to determine the need for intensive care. In addition, costs may be further reduced as the ICU length of stay may be decreased if there are no necessary interventions or complications after 12 hours of intensive care.