Peripheral Vascular Surgery Society
|
|
Peripheral Vascular Surgery Society |
|
|
|
#2. ESTIMATING THE CONTEMPORARY IN-HOSPITAL COSTS OF CAROTID ENDARTERECTOMY
Zachary K. Baldwin, MD, Shari L. Meyerson, MD, James F. McKinsey, MD, Hisham S. Bassiouny, MD, R. Loch MacDonald, MD, Bruce L. Gewertz, MD, and Lewis B. Schwartz, MD The University of Chicago, Chicago, IL
Purpose: Carotid endarterectomy (CEA) is the treatment of choice for symptomatic carotid stenosis and selective asymptomatic lesions. Alternative approaches have recently been championed under the guise of increased efficacy and decreased cost. The purpose of this study was to determine the results and in-hospital costs of CEA in a university hospital in the modern era.
Methods: A retrospective chart review was undertaken for all patients undergoing CEA between January 1996 and December 1997. This corresponded to the implementation of a clinical path and extended efforts toward cost reduction. Patients undergoing combined CEA and cardiopulmonary bypass were excluded (n=3). Cost was analyzed by the hospital Office of Program Planning using TSI (Transition Systems, Inc.) software. Direct costs are related to the utilization of clinical resources, and are therefore manageable by clinicians (bed, room, supplies, nursing staff, OR staff, radiology, pharmacy, etc.). Total costs additionally include administration and overhead costs not directly chargeable to patient accounts.
Results: Ninety-nine CEA's were performed in 95 patients. The mean age was 69 years with the expected frequency of risk factors (hypertension 75%, smoking 52%, coronary artery disease 44%, diabetes 33%, prior CABG 27%, redo operation 5%). Fifty-seven percent of patients were symptomatic from carotid stenosis and 63% were admitted on the same day as surgery (SDA). Intraoperative EEG attenuation was noted in 21% and intraluminal shunts were utilized in 22%. There was one major in-hospital complication (aspiration with prolonged intubation) and six minor complications (transient reintubation in three patients, reexploration for bleeding in two, and severe headache in one). Median length of stay was 2 days for the total group (range 1-51 days) and 1 day for those patients admitted on the day of surgery. Only 16% of patients required admission to the ICU. Median direct cost for the entire group was $3547, including $3028 for SDA patients. Median total cost for the entire group was $6672, including $5544 for SDA patients. There was one transient neurologic deficit occurring eight days after CEA that completely resolved following reexploration and revision. After a median follow-up of 10 months, there were two deaths (one cardiac arrest, one contralateral stroke following subsequent contralateral CEA), one asymptomatic 50-79% restenosis, and no ipsilateral neurologic events.
Conclusion: CEA can be safely performed without routine ICU admission and with very brief hospital stays. Alternative interventions would be unlikely to significantly improve outcomes or decrease costs.
Return to Master Program
Last updated January 10, 1999