Overnight hospital stay for carotid endarterectomy

To determine if overnight hospital stay after carotid endarterectomy (CEA) is feasible and safe in the Australian setting.

Case series with follow-up of 4-11 months (mean, 7 months).

All patients undergoing primary CEA performed by a vascular surgeon (BMB) between 30 May and 11 November 1996. Surgery was performed in one of four hospitals (a district general public hospital with about 400 beds and three private hospitals) in the Gosford area of New South Wales.

CEA using regional anaesthesia and sedation, after diagnosis by duplex ultrasound scan, avoiding cerebral angiography and intensive care; planned discharge after overnight hospital stay; review at one month and duplex ultrasound scan at four months.

Length of hospital stay and complications.

65 patients were admitted for CEA during the study period and 59 were scheduled for overnight stay (one had "re-do" surgery, two remained longer for reasons unrelated to carotid artery disease, and three had been scheduled before the change to overnight stay). 54 (92%) were discharged on the first postoperative day, and only three required readmission within 30 days (for urinary retention, angina and reperfusion syndrome). There were no deaths, no myocardial infarctions and no recognised instances of cerebral ischaemia during follow-up.

CEA can be performed safely without cerebral angiography or intensive care, with over 90% expectation of a single night's stay in hospital.