Impact of implementing good care and management practice guidelines in carotid revascularization procedures.

Autor: Massaud RM; Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, São Paulo, SP, 05652-900, Brazil. rmmassaud@gmail.com., da Silva MFA; Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, São Paulo, SP, 05652-900, Brazil., Vaccari AMH; Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, São Paulo, SP, 05652-900, Brazil., Silva GS; Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, São Paulo, SP, 05652-900, Brazil.; Disciplina de Neurologia Clínica, Universidade Federal de São Paulo, São Paulo, SP, Brasil., Wolosker N; Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, São Paulo, SP, 05652-900, Brazil.; Departamento de Cirurgia, Disciplina de Cirurgia Vascular E Endovascular, Universidade de São Paulo, São Paulo, SP, Brasil.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2022 Apr; Vol. 164 (4), pp. 1047-1053. Date of Electronic Publication: 2022 Jan 22.
DOI: 10.1007/s00701-022-05111-2
Abstrakt: Background: Studies assessing the effect of implementing good practice management guidelines (GPMG) in carotid revascularization within the same hospital are scarce. Thus, we aimed to evaluate the impact of GPMG implementation on the clinical outcomes of carotid revascularization procedures within a quaternary hospital.
Method: We retrospectively studied 177 patients with atherosclerotic carotid disease who underwent revascularization (carotid endarterectomy and carotid artery stenting) at a quaternary hospital between January 2012 and December 2019. The patients were divided into two groups: the pre-guideline group with 73 patients and the post-guideline group with 104 patients who underwent the procedures before and after the implementation of GPMG, respectively.
Results: Twelve (16.4%) and 3 (2.9%) patients had neurological complications in the pre- and post-guideline groups, respectively (p = 0.001); most complications were cases of ischemic stroke. There were fewer complications in men than in women (OR = 0.22; 95% CI 0.06-0.77). A significant decrease in neurological complications was observed in the carotid artery stenting group (pre-guideline 25.7% vs post-guideline 13.2%; p = 0.004). Logistic regression analysis of the predisposing factors for neurological complications in carotid endarterectomy and carotid artery stenting demonstrated that the implementation of GPMG was a determining factor for the improved results (odds ratio = 0.11, 95% CI 0.02-0.59).
Conclusions: Implementing GPMG for carotid revascularization resulted in better clinical results, with decreased neurological complications in patients that underwent angioplasty and endarterectomy.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
Databáze: MEDLINE
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