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Optimal resources for carotid endarterectomy
1Strong Memorial Hospital, University of Rochester Medical Center, N.Y.
Insights
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.
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.
Abstract:
This review compares the results and costs of carotid endarterectomy (CE) done by a single surgeon over a 1-year period working at both a university hospital (UH) and a community hospital (CH). Hospital and financial records of 157 patients were reviewed, 78 at UH and 79 at CH. The patient populations were matched for age, associated illnesses, and presenting symptoms. The principles of patient management were identical at both hospitals except that shunting requirements were determined by electroencephalographic monitoring at UH. There were no differences in the complication rates, and the combined stroke/mortality rate was 0.6%. The cost of CE was 56% greater on a per patient basis at UH ($3918 versus $6126, p less than 0.001) and 23% greater on a per diem basis at UH ($611 versus $755, p less than 0.001). Patients stayed longer at UH (8.2 days versus 6.6 days at CH, p less than 0.03). These differences are largely explained by three types of delays at UH. First, patients with cardiovascular accidents at UH were kept in the hospital before surgery until maximum improvement occurred whereas patients at CH were allowed to convalesce at home before CE. Patients operated on after a cardiovascular accident spent an average of 17.6 days in UH while a similar group spent only 7.3 days in hospital at CH (p less than 0.03). Second, delays in obtaining angiograms of greater than 2 hospital days occurred in 28% of patients at UH compared with only 10% at CH (p less than 0.05). Third, delays in scheduling operating room time of greater than 2 hospital days occurred in 17% of patients at UH and in only 7% of patients at CH (p less than 0.05). When there were no delays, the cost of treating patients at each hospital was identical, $3483 at CH and $3520 at UH. UH must accept the fact that equally good results can be obtained at CH, and although the potential exists for equal costs at both types of hospitals, the CH provides the service at a lower cost. UH administrators must address these inefficiences if the UH is to compete effectively in the current marketplace.