Holly Grunebach, Timothy Madeira, Sanuja Bose, Courtenay Holscher, Roberto G Aru, Christopher J Abularrage, James H Black, Ying Wei Lum, Bruce A Perler, Caitlin W Hicks
{"title":"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。","authors":"Holly Grunebach, Timothy Madeira, Sanuja Bose, Courtenay Holscher, Roberto G Aru, Christopher J Abularrage, James H Black, Ying Wei Lum, Bruce A Perler, Caitlin W Hicks","doi":"10.1016/j.amjsurg.2024.116056","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study investigated the outcomes before and after initiation of a postoperative care pathway for carotid endarterectomy (CEA) patients.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>Initiation of a CEA pathway was associated with lower ICU rates and reduction in hospital charges without compromising patient outcomes.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116056"},"PeriodicalIF":2.7000,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A standardized carotid endarterectomy care pathway is associated with lower ICU admission rates and a significant reduction in hospital charges.\",\"authors\":\"Holly Grunebach, Timothy Madeira, Sanuja Bose, Courtenay Holscher, Roberto G Aru, Christopher J Abularrage, James H Black, Ying Wei Lum, Bruce A Perler, Caitlin W Hicks\",\"doi\":\"10.1016/j.amjsurg.2024.116056\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study investigated the outcomes before and after initiation of a postoperative care pathway for carotid endarterectomy (CEA) patients.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>Initiation of a CEA pathway was associated with lower ICU rates and reduction in hospital charges without compromising patient outcomes.</p>\",\"PeriodicalId\":7771,\"journal\":{\"name\":\"American journal of surgery\",\"volume\":\" \",\"pages\":\"116056\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-11-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.amjsurg.2024.116056\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.amjsurg.2024.116056","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
A standardized carotid endarterectomy care pathway is associated with lower ICU admission rates and a significant reduction in hospital charges.
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.
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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