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(Stroke. 1999;30:2341-2346.)
© 1999 American Heart Association, Inc.

Original Contributions

Significant Reductions in Length of Stay After Carotid Endarterectomy Can Be Safely Accomplished Without Modifying Either Anesthetic Technique or Postoperative ICU Monitoring

Peter D. Angevine, MD; Tanvir F. Choudhri, MD; Judy Huang, MD; Donald O. Quest, MD; Robert A. Solomon, MD; J. P. Mohr, MD; E. J. Heyer, MD, PhD E. Sander Connolly, Jr, MD

From the Departments of Neurosurgery (P.D.A., T.F.C., J.H., D.O.Q., R.A.S., E.S.C.), Neurology (J.P.M.), and Anesthesia (E.J.H.), Columbia–Presbyterian Medical Center, New York, NY.

Correspondence to E. Sander Connolly, Jr, MD, Irving Assistant Professor, Department of Neurological Surgery, Columbia University, 710 W 168th St, Room 435, New York, NY 10032. E-mail esc5{at}columbia.edu

Background and Purpose—We sought to determine whether postoperative length of stay (LOS) and resource utilization could be safely reduced without changing our uniform protocol of performing carotid endarterectomy (CEA) under general anesthesia with postoperative intensive care unit monitoring.

Methods—We retrospectively reviewed the hospital records of 421 consecutive CEA operations performed during a 3-year period of transition in discharge policy to determine LOS, complications, and resource utilization. We divided operated patients into 3 cohorts: cohort I patients were operated on before a stay reduction policy was instituted (1995, n=171); cohort II patients were operated on after the institution of a single-day-stay policy for selected patients (January to August 1996, n=95); and cohort III patients were operated on after the institution of a universal single-day-stay policy (September 1996 to December 1997, n=155).

Results—While significant in-hospital complications leading to increased LOS remained essentially unchanged over time (cohort I: 4.0%; II: 6.3%; III: 3.9%; P=NS), the mean postoperative LOS decreased from 2.6±0.3 days in cohort I to 1.6±0.1 days in cohort III (P<0.0001). The median postoperative LOS also decreased from 2 days to 1 day from cohort I to III, with 70% of patients discharged after 1 day in cohort III compared with only 32% for cohort I (P<0.0001). In addition, the total number of laboratory studies ordered decreased from 8.0±0.8 per patient in cohort I to 6.4±0.5 in cohort III (P<0.01).

Conclusions—A uniform policy of discharge home from the intensive care unit on postoperative day 1 following CEA under general anesthesia can reduce LOS and decrease resource utilization without compromising care.

Key Words: carotid endarterectomy • costs and cost analysis • hospitalization • quality of health care