Carotid endarterectomy: What difference does a clinical protocol make?

Area of Science:

• Vascular Surgery
• Health Policy
• Patient Outcomes

Background:

• The initial postoperative period after carotid endarterectomy (CEA) is critical for patient outcomes, with hypotension being a common complication.
• Current postoperative management protocols for CEA vary, often involving intensive care unit (ICU) or high-dependency unit admissions.
• Hypotension episodes post-CEA were identified as a significant issue, prompting a policy revision at the study hospital.

Purpose of the Study:

• To compare short-term clinical outcomes following a revised postoperative management policy for carotid endarterectomy (CEA).
• To evaluate the impact of policy changes on patient management and resource utilization after CEA.

Main Methods:

• A retrospective review of health records was conducted for two periods: pre-policy change (July 2008-June 2009) and post-policy change (June 2011-May 2012).
• Hypotension was defined as systolic blood pressure < 90 mm Hg.
• Statistical analysis was performed using State SE 12.1, controlling for confounding factors like age, gender, and heart rate.

Main Results:

• Patients under the post-policy change group were significantly less likely to require vasoactive medications for blood pressure management (OR, 0.33; 95% CI, 0.12-0.91; P=0.026).
• The revised policy avoided over 90% of intensive care unit admissions for CEA patients.
• An estimated cost saving of $807 Australian dollars per patient was achieved with the updated policy.

Conclusions:

• The revised postoperative management policy for carotid surgery, including extended Recovery Unit observation, has improved patient care.
• The updated policy represents a cost-effective and safer approach to managing patients after CEA.
• Clinical Nurse Consultant involvement was crucial for the successful development, implementation, and evaluation of the policy change.