Five-step protocol for carotid endarterectomy in the managed health care era.

摘要: Abstract Background: We developed a protocol combining 5 cost-effective strategies to determine whether elective carotid endarterectomy (CEA) could be performed safely without adversely affecting well-established low morbidity and mortality rates with significant hospital cost savings. Methods: Between April 1, 1995, December 31, 1996, 109 of 141 patients were prospectively enrolled as candidates into 5-step CEA protocol: (1) duplex ultrasonography (DU) at an accredited vascular laboratory the sole diagnostic preoperative study, (2) admission day operation, (3) cervical block anesthesia eliminate intraoperative electroencephalogram monitoring, (4) transfer from recovery room after 4-hour observation period ward, (5) discharge first postoperative morning. The other 32 excluded analysis; 16 treated by surgeons not participating in protocol, 9 concomitantly for medical problems, 7 admitted emergently. Results: One patient died hemorrhage morning, one had embolic stroke combined mortality-stroke rate 1.8% (2 109). Of patients, 70% (76) underwent operation using DU 95% (104) 76% (83) anesthesia, 59% (64) transferred floor 83% (90) discharged morning operation. None affected these cost-saving except potentially who bled predicted charges perioperative that many currently use (preoperative arteriography, general overnight intensive care unit stay, on 2) was $16,073 compared $10,437 completed all steps detailed above. Conclusions: On basis results documenting savings acceptably rates, this may considered standard performing era containment. These endovascular intervention, which has recently been proposed less expensive technique treat disease. (Surgery 1999;125:96-101.)