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Published on: August 12, 2014
Discharge on the first postoperative day after elective carotid endarterectomy
Pierre Van den Brande1, Isolde Van Heymbeeck1, Erik Debing1
1Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Insights
Most patients undergoing carotid endarterectomy (CEA) can be safely discharged on the first postoperative day. Social factors, not medical issues, often delay discharge, with no increase in readmissions for CEA complications.
Area of Science:
- Vascular Surgery
- Patient Outcomes
- Healthcare Management
Background:
- Medical complications can extend hospital stays post-elective carotid endarterectomy (CEA).
- Assessing the feasibility and safety of same-day discharge after CEA is crucial for optimizing patient care and hospital resources.
- Unplanned readmissions following CEA require careful monitoring and analysis.
Purpose of the Study:
- To prospectively evaluate the social and medical feasibility of discharging patients on the first postoperative day after elective carotid endarterectomy (CEA).
- To determine the safety of early discharge, specifically examining unplanned readmissions and postoperative complications.
- To identify factors influencing discharge timing and readmission rates.
Main Methods:
- A prospective study enrolled 57 consecutive patients undergoing elective CEA between June 2011 and January 2012.
- Patients were candidates for first-day postoperative discharge if medically stable and had social support at home.
- Post-discharge follow-up assessed for hypertension, cerebral hyperperfusion, focal ischemia, and hospital readmissions up to 30 days.
Main Results:
- Of 62 CEAs performed, 73% of patients were discharged on the first postoperative day.
- Delayed discharge (day 2 or later) was primarily due to lack of social support (12 cases) rather than medical reasons (3 cases).
- No perioperative strokes, deaths, or 30-day readmissions related to the CEA procedure were observed.
Conclusions:
- The majority of patients undergoing elective CEA can be safely discharged on the first postoperative day.
- Social factors are the primary determinant for delayed discharge, highlighting the need for adequate home support.
- Early discharge following CEA is safe and does not lead to an increase in unplanned readmissions for procedure-related complications.
Background:
Medical complications may prolong the hospital stay after elective carotid endarterectomy (CEA). We prospectively assessed the social and medical feasibility and safety of patient discharge on the first postoperative day after elective CEA and unplanned readmissions.
Methods:
Between June 2011 and January 2012, 57 consecutive patients scheduled for elective CEA were enrolled with the aim of discharge on the first postoperative day if there were no medical contraindications and on the condition that the patient should not be left alone during the first day and night at home. CEA was carried out under local or general anesthesia. After discharge, the patients were contacted to ascertain the occurrence of arterial hypertension, cerebral hyperperfusion, focal cerebral ischemia, or hospital readmission.
Results:
Sixty-two CEA were carried out in 57 patients (33 men and 24 women ranging in age from 51-89 years). The indications for CEA were: asymptomatic high grade stenosis in 27, hemispheric transient ischemic attack in 12, amaurosis fugax in 6, recovered stroke in 16, and nonlateralizing signs in 1. There were no cases of perioperative stroke or death. Discharge on the first postoperative day was achieved in 45 cases (73%). In 15 cases (24%), discharge was on the second postoperative day because of the absence of a relative (12 cases) or for medical reasons (3 cases). Discharge was on day 3 in 1 case, and on day 10 in another, both for medical reasons. No cases of severe arterial hypertension, stroke, mortality, or readmission for reasons related to the CEA procedure were recorded up to postoperative day 30.
Conclusion:
In this study, the majority of patients undergoing elective CEA were discharged safely on the first postoperative day. Social reasons, rather than medical reasons, underlied most cases of later discharge. There were no unplanned readmissions for complications of CEA.
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