Objective
To determine whether 1-day postoperative hospitalization after carotid endarterectomy is safe and the degree to which this can be achieved.
Design
Consecutive sample series of all carotid endarterectomies performed by a single surgical group.
Setting
A single tertiary-care hospital.
Patients
All who underwent carotid endarterectomy. Patients with procedures combined with coronary revascularization and patients undergoing the first part of a staged bilateral carotid endarterectomy performed in 1 hospitalization were excluded.
Intervention
In December 1993, a fast-track protocol was initiated, aiming for a 1-day stay after carotid endarterectomy without admission to an intensive care unit (ICU). Before this date, postoperative care included obligatory monitoring for at least 1 night in an ICU.
Main Outcome Measures
Length of stay, admission to and stay in the ICU, complications, and hospital readmission rate.
Results
Over a 21-month period, 152 patients had 163 carotid endarterctomies. Of these, 124 were elective and 39 urgent (patients with a critical stenosis). Indications were stroke (n=14 [8.6%]), transient ischemic attack (n=50 [30.7%]), amaurosis fugax (n=36 [22.1%]), and asymptomatic stenosis (n=63 [38.7%]). General anesthesia was used for 159 procedures, cervical block for 4. Mean operation time was 2.6 hours. Postoperative stay was 1 day for 82 procedures (50%), 2 days for 49 procedures (30%), 3 days for 12 procedures (7%), and longer for 20 procedures (12%). In the last half of the study, 61% of patients (50/82) were discharged on postoperative day 1 and 87% (71/82) by postoperative day 2. One hundred three patients went to a surgical floor postoperatively. Overall, 60 patients went to the ICU, but only 18 (22%) of the last 82 procedures required ICU admission. The total stay averaged 3.8 days. Twenty-one patients (13%) experienced complications, including 3 deaths within 30 days and 5 neurological deficits. There were 14 early readmissions, but none was attributable to discharge on the first or second postoperative day.
Conclusions
Early discharge home after carotid endarterectomy is safe and efficacious, and obligatory admission to an ICU is not necessary. At least 60% of patients who undergo carotid endarterectomy can have a postoperative stay of 1 day, and more than 80% can be discharged by postoperative day 2. A short postoperative stay is not associated with a significant risk of readmission for complications.
Arch Surg. 1996;131:751-755
