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Carotid endarterectomy: a safe cost-efficient approach.

P E Collier1

  • 1Department of Surgery, Sewickley Valley Hospital, PA.

Journal of Vascular Surgery
|December 1, 1992
PubMed
Summary

Early discharge after carotid endarterectomy is safe and effective. This study shows most patients can go home the first day, reducing intensive care unit (ICU) stays and length of hospital stay.

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Area of Science:

  • Vascular Surgery
  • Patient Outcomes
  • Healthcare Efficiency

Background:

  • Diagnosis-related groups (DRGs) incentivize efficiency, raising safety concerns.
  • Traditional carotid endarterectomy protocols involved 24-hour ICU monitoring and second-day discharge.
  • Review indicated many patients did not require intensive care unit (ICU) stays.

Purpose of the Study:

  • To evaluate the safety and efficacy of an early discharge policy for carotid endarterectomy.
  • To assess outpatient arteriography, same-day admission, and selective ICU use.

Main Methods:

  • Prospective policy established in January 1991.
  • Evaluation of 52 patients undergoing carotid endarterectomy over 10 months.
  • Data collected on patient history, anesthesia, shunting, ICU use, and discharge timing.

Main Results:

  • 88% of patients discharged on the first postoperative day.
  • Average length of stay was 1.29 days.
  • Only 5 patients required ICU admission for complications (hypertension, hypotension, neurologic events).

Conclusions:

  • Early discharge (first postoperative day) is feasible and safe for select carotid endarterectomy patients.
  • Outpatient arteriography and same-day admission are effective components of this protocol.
  • Selective ICU use improves healthcare efficiency without compromising patient safety.

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