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

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2025-01-01 DOI:10.1016/j.amjsurg.2024.116056

Holly Grunebach , Timothy Madeira , Sanuja Bose , Courtenay Holscher , Roberto G. Aru , Christopher J. Abularrage , James H. Black III , Ying Wei Lum , Bruce A. Perler , Caitlin W. Hicks

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Abstract

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.

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标准化颈动脉内膜剥脱术护理路径可降低重症监护室入院率，并显著降低住院费用。

背景本研究调查了颈动脉内膜剥脱术（CEA）患者术后护理路径启动前后的结果：方法：与利益相关者共同制定了颈动脉内膜剥脱术（CEA）护理路径。我们比较了CEA实施前18个月（2019年11月至2021年4月）与实施后18个月（2021年5月至2022年11月）接受CEA手术患者的院内治疗效果和费用（美元）：149名患者（平均年龄为70.2 ± 10.9岁，60.4%为男性，75.7%为白人）接受了CEA手术（实施前83人，实施后66人）。重症监护室（ICU）护理明显减少（90.4% 对 46.2%；P 0.12）。经过风险调整后，该路径可使每位患者/天的费用减少1631美元（95%CI -3008美元，-254美元）：结论：在不影响患者预后的情况下，CEA路径的启动与ICU率降低和住院费用减少有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.

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