A standardized carotid endarterectomy care pathway is associated with lower ICU admission rates and a significant reduction in hospital charges.

Autor: Grunebach H; The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: hgruneb1@jh.edu., Madeira T; The Johns Hopkins Hospital, Baltimore, MD, USA., Bose S; Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Holscher C; Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA., Aru RG; Thomas Jefferson University Hospital, 833 Chestnut st. Ste. 703, Philadelphia, PA, 19107, USA., Abularrage CJ; Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Black JH 3rd; Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Lum YW; Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Perler BA; Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Hicks CW; Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: chicks11@jhmi.edu.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2025 Jan; Vol. 239, pp. 116056. Date of Electronic Publication: 2024 Nov 10.
DOI: 10.1016/j.amjsurg.2024.116056
Abstrakt: Background: This study investigated the outcomes before and after initiation of a postoperative care pathway for carotid endarterectomy (CEA) patients.
Methods: A CEA pathway was developed with stakeholders. We compared in-hospital outcomes and charges (USD) for patients undergoing CEA 18 months before (11/2019-04/2021) vs. after (05/2021-11/2022) implementation.
Results: 149 patients (mean age 70.2 ​± ​10.9 years, 60.4 ​% male, 75.7 ​% white) underwent CEA (83 pre-initiative, 66 post-initiative). There was significant reduction in intensive care unit (ICU) care (90.4 ​% vs.46.2 ​%; P ​< ​0.001) but no changes in stroke (3.6 ​% vs. 0 ​%), death (0 ​% vs. 0 ​%), or median length-of stay (1.0 vs. 1.0 days) following implementation (all, P ​> ​0.12). After risk adjustment, the pathway was associated with charge reductions of $1631/patient/day (95%CI -$3,008, -$254).
Conclusions: Initiation of a CEA pathway was associated with lower ICU rates and reduction in hospital charges without compromising patient outcomes.
Competing Interests: Declaration of competing interest CWH reports consulting relationships with Cook Medical LLC, W.L. Gore, and Silk Road Medical that are unrelated to this work. The remaining authors have no conflicts of interest for this work.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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