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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.
Insights
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.
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.
Background:
Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit including outcome measures.
Methods:
A consecutive series of 333 patients admitted over 7 years under a single consultant surgeon were studied. Outcome measures included the rate of perioperative neurological complication of any kind, and death. The length of hospital stay and the number of readmissions within 30 days were recorded prospectively by computerized audit.
Results:
Over the interval of the study, the number of preoperative investigations was reduced; angiography and cerebral computed tomography were reserved for specific indications. The median duration of hospital stay decreased from 7 to 2 days. There was no change in the stroke and death rate (3 per cent) during the study and only two patients required readmission within 30 days.
Conclusion:
Carotid endarterectomy can be performed cost-effectively using non-invasive preoperative investigations for the majority of patients. In-hospital stay has been reduced and the routine use of intensive care replaced by a 2-h stay in theatre recovery. These changes have been achieved without compromising patient safety.
