[Carotid endarterectomy: postoperative morbimortality and requirements for intensive care]

To analyze risk factors, morbidity and mortality of carotid endarterectomy, and to determine whether prolonged attention in the postoperative intensive care recovery unit is needed by all patients.

A retrospective study of 102 carotid endarterectomy patients between January 1991 and February 1997. The following data were analyzed: preoperative risk factors, prior neurologic symptoms, time of stay in the recovery unit, postoperative complications requiring intensive treatment and the time of onset of such events, and mortality after 30 days.

Some type of postoperative complication developed in 35% of patients in the recovery unit, requiring specialized medical attention; 94.8% occurred within eight hours of admission to the unit and the most common complication was hypertension. After transfer to the ward, 9 more patients (8.8%) suffered severe complications, most commonly coronary ischemia. Mortality was 1.9% and the combined rate of mortality plus severe neurologic event was 2.9%. Preoperative hypertension and the presence of more than three risk factors in the same patient was statistically related to the development of postoperative complications. Presurgical coronary disease was related to postoperative ischemic complications.

Patients undergoing carotid endarterectomy with fewer than four risk factors and no ischemic heart disease or severe hypertension can probably be transferred to the hospital ward eight hours after admission to the recovery unit if no complications have developed, thus reducing hospital costs. We believe that appropriate vigilance of such patients should then be provided on the ward.