Carotid endarterectomy outcomes research: reduced resource utilization using a clinical protocol

Area of Science:

• Vascular Surgery
• Critical Care Medicine
• Health Services Research

Background:

• Carotid endarterectomy (CEA) is a common procedure to prevent stroke.
• Intensive care unit (ICU) admission post-CEA is standard practice but may not be necessary for all patients.
• Optimizing postoperative care pathways can improve resource allocation.

Purpose of the Study:

• To evaluate the necessity of ICU utilization after CEA.
• To identify criteria for managing CEA patients on a general vascular unit.
• To develop and implement a clinical protocol for postoperative patient disposition.

Main Methods:

• Retrospective review of 50 patients admitted to the ICU post-CEA.
• Prospective study of 200 patients managed via a clinical protocol, allocated to either vascular unit or ICU.
• Comparison of outcomes including mortality, stroke, myocardial infarction, and length of stay.

Main Results:

• No significant differences in morbidity or mortality between vascular unit and ICU groups.
• Prospective protocol successfully directed 63% of patients to the vascular unit.
• Implementation of the protocol significantly decreased ICU length of stay (1.4 to 0.6 days) and resulted in average cost savings of $1043 per patient.

Conclusions:

• A clinical protocol can effectively select patients for ICU or vascular unit admission post-CEA without compromising safety.
• Selective ICU use conserves resources and reduces length of stay.
• The protocol offers substantial cost savings and maintains comparable patient outcomes.