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Cost-effective carotid endarterectomy.

A J Sandison1, C H Wood, T S Padayachee

  • 1Departments of Surgery, Anaesthesia, Ultrasonic Angiology and Neurology, Guy's and St Thomas' Hospital Trust, Guy's Hospital, London, UK.

The British Journal of Surgery
|March 16, 2000
PubMed
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Carotid endarterectomy can be performed cost-effectively by reducing preoperative investigations and hospital stay. This approach maintained excellent patient safety outcomes, demonstrating efficient vascular surgery practices.

Area of Science:

  • Vascular Surgery
  • Health Economics
  • Clinical Audit

Background:

  • Carotid endarterectomy (CEA) is an important procedure for stroke prevention.
  • Evidence suggests CEA may be underutilized in the UK.
  • Cost-effectiveness of CEA requires evaluation within clinical practice.

Purpose of the Study:

  • To assess methods for reducing costs in a vascular unit performing CEA.
  • To evaluate the impact of changes on patient outcomes through continuous audit.

Main Methods:

  • A consecutive series of 333 patients undergoing CEA over 7 years were studied.
  • Prospective computerized audit recorded perioperative neurological complications, death, length of hospital stay, and 30-day readmissions.
  • Preoperative investigations were streamlined, reserving advanced imaging for specific indications.

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Main Results:

  • The median hospital stay decreased significantly from 7 to 2 days.
  • Perioperative stroke and death rates remained stable at 3%.
  • Only two patients required readmission within 30 days.

Conclusions:

  • Carotid endarterectomy can be performed cost-effectively with streamlined, non-invasive preoperative assessments.
  • Reduced in-hospital stay and elimination of routine intensive care use were achieved.
  • These efficiency improvements did not compromise patient safety or clinical outcomes.