Carotid endarterectomy outcomes research: reduced resource utilization using a clinical protocol

Background and purpose: The purpose of this study was to examine the necessity of intensive care unit (ICU) utilization following carotid endarterectomy (CEA) and to identify patients who can be managed postoperatively on a vascular unit using a clinical protocol. Methods: Medical records of SO patients admitted to the ICU following elective CEA were reviewed retrospectively for patient characteristics, morbidity, mortality, length of stay (LOS), and ICU intervention. Prospectively, the next 200 patients were routed to either a vascular unit or ICU, based on a clinical protocol. Endpoints were mortality, stroke, myocardial infarction, total hospital LOS, ICU LOS, and ICU intervention. Results: There were no significant differences in morbidity or mortality between patients admitted to the vascular unit and those admitted to the ICU, Of patients evaluated prospectively, 129 (63%) were admitted directly to the vascular unit. Of the 73 patients admitted to the ICU, 63% required direct intervention compared with only 54% of patients in the retrospective series (P = 0.001). In addition, after institution of the protocol. ICU LOS decreased significantly from 1.4 to 0.6 days (P < 0.001). The hospital cost savings using this protocol averaged $1043 per patient. Conclusions: A clinical protocol can select patients for admission to the ICU or the Vascular unit following CEA without increase in morbidity or mortality. Selective use of the ICU conserved resources, decreased ICU LOS, and provided substantial cost savings. (C) 2000 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.