Carotid endarterectomy with shortened hospital stay
S. G. Katz and R. D. Kohl
Department of Surgery, Huntington Memorial Hospital, Pasadena, Calif., USA.
OBJECTIVE: To review the outcome of a consecutive series of patients
undergoing carotid endarterectomy with a focus on length of stay. DESIGN:
Retrospective case review. SETTING: Six hundred-bed community hospital.
PATIENTS: During a 40-month period, we performed 266 carotid
endarterectomies. Ages of patients ranged from 49 to 91 years (mean, 71.2
years). Seventy-two percent were hypertensive, 55% were smokers, 24% were
diabetic, and 22% had symptomatic heart disease. Indications for operation
included asymptomatic stenosis in 48% of patients, transient ischemia
attack in 23%, stroke in 24%, and nonhemispheric symptoms in 5%. OUTCOME
MEASURES: Perioperative complications and conditions precluding early
hospital discharge were noted. In patients discharged within 48 hours of
operation, problems requiring readmission within 30 days were recorded.
RESULTS: Five patients (1.9%) experienced perioperative strokes, of which
three were permanent and two temporary. There was one perioperative death.
Hospital stays ranged from 1 to 9 days (mean 1.7 days). Sixty-three percent
of the patients were discharged within 24 hours and 88% within 48 hours of
operation. Patients staying in the hospital more than 48 hours were
significantly older (P = .008). Other factors did not correlate with length
of stay. Readmission was required in five patients. CONCLUSIONS: Patients
having an uneventful course following carotid endarterectomy may be safely
discharged within 48 hours of operation. Complications occurring after this
time are infrequent and often unpredictable. It is unlikely that
lengthening patient stay would decrease or eliminate these complications.
