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Carotid endarterectomy outcomes research: reduced resource utilization using a clinical protocol
D C Hobart1, G G Nicholas, J F Reed
1Department of Surgery, Lehigh Valley Hospital, Cedar Crest & 1-78, PO Box 689, Allentown, PA 18105-1556, USA.
Insights
A clinical protocol can safely guide patients after carotid endarterectomy (CEA) to either an intensive care unit (ICU) or a vascular unit, reducing ICU length of stay and saving costs.
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.
Background And Purpose:
The purpose of this study was to examine the necessity of intensive care unit (ICU) utilization following carotid endarterectomy (CEA) and to identify patients who can be managed postoperatively on a vascular unit using a clinical protocol.
Methods:
Medical records of 50 patients admitted to the ICU following elective CEA were reviewed retrospectively for patient characteristics, morbidity, mortality, length of stay (LOS), and ICU intervention. Prospectively, the next 200 patients were routed to either a vascular unit or ICU, based on a clinical protocol. Endpoints were mortality, stroke, myocardial infarction, total hospital LOS, ICU LOS, and ICU intervention.
Results:
There were no significant differences in morbidity or mortality between patients admitted to the vascular unit and those admitted to the ICU. Of patients evaluated prospectively, 129 (63%) were admitted directly to the vascular unit. Of the 73 patients admitted to the ICU, 63% required direct intervention compared with only 54% of patients in the retrospective series (P=0.001). In addition, after institution of the protocol, ICU LOS decreased significantly from 1.4 to 0.6 days (P<0.001). The hospital cost savings using this protocol averaged $1043 per patient.
Conclusions:
A clinical protocol can select patients for admission to the ICU or the vascular unit following CEA without increase in morbidity or mortality. Selective use of the ICU conserved resources, decreased ICU LOS, and provided substantial cost savings.
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