Carotid Endarterectomy Performed before the Weekend is Associated with Increased Length of Stay

Objective: Length of stay (LOS) is commonly used to gauge hospital resource utilization and can affect hospital profit margin. Other fields of surgery have showed that operations performed close to the weekend have longer LOS and higher patient morbidity. Our goal was to investigate whether asymptomatic patients undergoing elective carotid endarterectomy (CEA) earlier in the week had a shorter LOS and improved clinical outcomes compared to those treated before the weekend. Methods: The Vascular Quality Initiative database was queried for elective weekday CEAs performed for asymptomatic carotid stenosis from 2005 to 2017. Univariate and multivariate analyses were completed to compare outcomes based on the day of the week. Results: There were 26,882 asymptomatic CEAs performed on Monday (20.3%), Tuesday (23.0%), Wednesday (21.3%), Thursday (18.8%), and Friday (16.6%). The mean patient age was 70.5 years, and 59.2% were male. Thirty-day mortality (0.4%) and perioperative complications including stroke (1.4%), myocardial infarction (0.7%), and return to the operating room (1.5%) were not significantly different across weekdays. Patients were discharged on statins in 84.2% of cases and aspirin in 91.5% of cases. The mean LOS ranged from 1.6 +/- 2.2 days to 1.8 +/- 3.2 days. CEAs performed on Fridays had a longer LOS (1.8 +/- 2.4; P < 0.001). Multivariate analysis demonstrated that CEAs performed on Friday had longer LOS compared to those performed on Monday through Thursday (means ratio: 1.05, 95% confidence interval [CI]: 1.03-1.07; P < 0.001). However, there were no differences in perioperative complications to attribute this to. Friday CEA did not have an effect on discharge medication compliance with aspirin (odds ratio: 0.94, 95% CI: 0.82-1.07; P = 0.339) or statin medications (odds ratio: 0.90, 95% CI: 0.79-1.03; P = 0.126). Conclusion: Asymptomatic CEA performed before the weekend was associated with longer LOS although there were no differences in perioperative mortality, morbidity, and discharge medication compliance. Such LOS increase, albeit small, may affect the hospital profit margin for the procedure and performing an elective CEA on asymptomatic patients earlier in the week may benefit in a shorter LOS. Improved team staffing and resources on weekends are potential areas for improvement for earlier discharge; however, further investigation is needed.