Decreasing carotid endarterectomy length of stay at a university hospital

In 1995, a clinical pathway for carotid endarterectomy patients was instituted at the authors' institution. The effect of this program on length of stay and patient outcomes was investigated. Records of 152 consecutive carotid endarterectomies performed by a single surgeon over a 45-month period with identical technique (general anesthesia, routine shunting, closure with a dacron patch) were reviewed. Comparison of patients treated under the pathway (n = 119) and those prior to that policy (n = 33) revealed no significant differences (P>0.05) in age, sex, co-morbid conditions, or surgical indication. No difference (P>0.05) was found for occurrence of complications, which included two fatal perioperative strokes (1.3%) and two myocardial infarctions (1.3%) (one fatal). No complications occurred after discharge and no patients required readmission to the hospital. Average length of stay was reduced from 6.0 to 3.3 days, with 78% of patients discharged within 48 h. Preoperative hospitalization decreased from 100 to 21%. A decrease in the use of preoperative arteriography from 100 to 10% was noted. The cost of vascular studies decreased from $2451 to $1228. Cost-saving measures, including early discharge of stable patients, elimination of preoperative hospitalization and decreased use of arteriography, can be accomplished while maintaining acceptable complication rates following carotid endarterectomy in a university hospital setting.