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Optimal resources for carotid endarterectomy.

R M Green¹, J McNamara

¹Strong Memorial Hospital, University of Rochester Medical Center, N.Y.

|October 1, 1987

Summary

Carotid endarterectomy (CE) yielded similar outcomes at university and community hospitals, but university hospital costs were significantly higher due to longer patient stays and procedural delays. Optimizing hospital workflows can reduce costs.

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Area of Science:

Vascular Surgery
Health Services Research
Healthcare Economics

Background:

Carotid endarterectomy (CE) is a crucial procedure for preventing stroke.
Comparing surgical outcomes and costs between different healthcare settings is essential for efficiency.
Previous studies have not fully elucidated cost disparities in CE between university and community hospitals.

Purpose of the Study:

To compare the clinical outcomes and associated costs of carotid endarterectomy (CE) performed by a single surgeon at a university hospital (UH) versus a community hospital (CH).
To identify factors contributing to cost differences between the two hospital types.

Main Methods:

A retrospective review of 157 patients undergoing CE by one surgeon over one year was conducted.
Patient data from UH (n=78) and CH (n=79) were analyzed, matching for age, comorbidities, and symptoms.
Hospital records, financial data, and procedural timelines were examined to assess outcomes and costs.

Main Results:

No significant differences in complication rates or combined stroke/mortality (0.6%) were observed between UH and CH.
CE costs were 56% higher per patient at UH ($6126 vs. $3918) and 23% higher per diem ($755 vs. $611).
Longer hospital stays at UH (8.2 vs. 6.6 days) were attributed to pre-operative delays for cardiovascular accidents, angiography, and operating room scheduling.

Conclusions:

Equally effective CE results can be achieved in community hospitals at a lower cost.
University hospitals incur higher costs primarily due to operational inefficiencies and delays, not differences in surgical quality.
Addressing delays in patient management and scheduling is critical for university hospitals to reduce costs and improve competitiveness.

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