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Carotid endarterectomy with shortened hospital stay
Insights
Patients undergoing carotid endarterectomy can be safely discharged within 48 hours if they have an uneventful recovery. Early discharge for carotid endarterectomy patients is safe and effective.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Cardiovascular Surgery
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Optimizing hospital length of stay is crucial for resource management and patient flow.
Purpose of the Study:
- To evaluate the outcomes of carotid endarterectomy, focusing on patient length of stay.
- To determine the safety and feasibility of early hospital discharge after carotid endarterectomy.
Main Methods:
- Retrospective case review of 266 patients undergoing carotid endarterectomy over 40 months.
- Data collected included patient demographics, comorbidities, indications for surgery, perioperative complications, and length of stay.
- Readmission rates within 30 days were analyzed for patients discharged within 48 hours.
Main Results:
- The mean length of hospital stay was 1.7 days, with 88% of patients discharged within 48 hours.
- Perioperative stroke rate was 1.9% (3 permanent, 2 temporary), with one perioperative death.
- Older age was the only significant factor correlating with a longer hospital stay (>48 hours).
Conclusions:
- Carotid endarterectomy patients with an uneventful recovery can be safely discharged within 48 hours.
- Extending hospital stay beyond 48 hours is unlikely to reduce infrequent and unpredictable complications.
- Early discharge protocols for carotid endarterectomy are supported by these findings.
Objective:
To review the outcome of a consecutive series of patients undergoing carotid endarterectomy with a focus on length of stay.
Design:
Retrospective case review.
Setting:
Six hundred-bed community hospital.
Patients:
During a 40-month period, we performed 266 carotid endarterectomies. Ages of patients ranged from 49 to 91 years (mean, 71.2 years). Seventy-two percent were hypertensive, 55% were smokers, 24% were diabetic, and 22% had symptomatic heart disease. Indications for operation included asymptomatic stenosis in 48% of patients, transient ischemia attack in 23%, stroke in 24%, and nonhemispheric symptoms in 5%.
Outcome Measures:
Perioperative complications and conditions precluding early hospital discharge were noted. In patients discharged within 48 hours of operation, problems requiring readmission within 30 days were recorded.
Results:
Five patients (1.9%) experienced perioperative strokes, of which three were permanent and two temporary. There was one perioperative death. Hospital stays ranged from 1 to 9 days (mean 1.7 days). Sixty-three percent of the patients were discharged within 24 hours and 88% within 48 hours of operation. Patients staying in the hospital more than 48 hours were significantly older (P = .008). Other factors did not correlate with length of stay. Readmission was required in five patients.
Conclusions:
Patients having an uneventful course following carotid endarterectomy may be safely discharged within 48 hours of operation. Complications occurring after this time are infrequent and often unpredictable. It is unlikely that lengthening patient stay would decrease or eliminate these complications.