A carotid endarterectomy critical pathway (CP) targeting a 3-day postoperative course was introduced in March 1994.
This retrospective analysis assesses its impact on operative results, postoperative length of stay (POD), and cost of hospitalization (COH).
One hundred eighty-six patients who underwent 201 carotid endarterectomy procedures from Nov. 1992 to Feb. 1994 (Pre-CP ; n=67) and from Apr. 1994 to Jul. 1995 (Post-CP ; n=134) at Johns Hopkins Hospital, a tertiary care referral center, were evaluated.
The Pre-CP and Post-CP groups had similar risk factors, postoperative morbidity rates, and mortality rates.
Furthermore, they had similar mean POD (Pre-CP, 6.0 ± 0.5 days ; Post-CP, 5.7 ± 0.6 days ; p=0.79) and COH.
However, only 85 of the Post-CP (63%) patients were actually placed on the CP (CP-starters) ; the mean POD was 3.4 ± 0.3 days among these CP-starters (p<0.0001) and 2.8 ± 0.1 days among the 74 Post-CP patients (55%) that remained on the pathway (CP-finishers ; p<0.0001).
The mean COH was reduced from $12,881 (Pre-CP) to $9701 for the CP-starters (p=0.01) and to $8572 for the CP-finishers (p=0.0001).
However, we found that only 47 of the Pre-CP patients (70%) would have been eligible for the CP, and the mean POD among those cases was 4.2 ± 0.4 days, which was not different than the mean POD among the CP-starters (p=0.17). (...)
Mots-clés Pascal : Endartériectomie, Carotide, Contrôle coût, Technique, Stratégie, Etats Unis, Amérique du Nord, Amérique, Centre hospitalier universitaire, Pronostic, Aspect économique, Homme, Chirurgie
Mots-clés Pascal anglais : Endarteriectomy, Carotid, Cost control, Technique, Strategy, United States, North America, America, Teaching hospital, Prognosis, Economic aspect, Human, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0448488
Code Inist : 002B30A04B. Création : 03/02/1998.