Effect of anesthetic management on resource utilization and outcome in carotid endarterectomy patients

Several well-controlled randomized trials have demonstrated the efficacy of carotid endarterectomy for prevention of stroke in patients with symptomatic, severe (> 70%) internal carotid artery stenosis. This benefit has resulted in a significant increase in the number of carotid endarterectomies performed annually. However, the benefit of carotid endarterectomy depends on low perioperative stroke, death and complication rates. This fact has drawn the attention of third party payers and there is considerable emphasis on further decreasing complications and medical expenditures. Implementations of clinical pathways and preventive strategies to obviate complications that increase length of stay and hospital costs have been critical. Although the incidence of perioperative stroke has decreased considerably over the recent years, cardiac and other systemic complications have remained relatively stable. Even though there is no unequivocal evidence of one anesthesia technique over another, several trials have suggested suggested improved clinical outcomes and economic benefit for carotid endarterectomies performed under regional anesthesia. This article describes a study at West Virginia University to assess the role of anesthetic management upon resource utilization and outcome in patients undergoing carotid endarterectomy.