Changing practice and costs of carotid endarterectomy in Toronto, Canada.
Background and Purpose-During our annual audits of carotid endarterectomy (CEA) in Toronto metropolitan hospitals, we have been aware of major changes in the practice of this operation in recent years.
To evaluate the effect of changing practice on costs of carotid endarterectomy, we have therefore compared the effects of changes in length of stay, complication rates, and other variables on cost during the last 3 years for which we have complete data.
Methods-We evaluated 757 consecutive patients, of whom 600 had CEA procedures in 3 teaching hospitals, and 190 procedures in 2 community hospitals in metropolitan Toronto.
We estimated costs using a specially designed computer program, Transitional System Incorporated, including surgical complications, in patients admitted between January 1994 and December 1996.
There was a significant decrease in length of stay in both groups of hospitals, mainly due to preoperative outpatient evaluation but also due to lower complication rates, which probably reflect an increase in asymptomatic surgery in both hospital groups.
Costs fell from approximately $8000 per procedure to $5000 in asymptomatic patients and from approximately $10 000 to $7000 in symptomatic patients (Can $). Conclusions-Major changes in the management of patients undergoing CEA have resulted in a significant decrease in both length of hospital stay and utilization of postoperative intensive care. (...)
Mots-clés Pascal : Endartériectomie, Carotide, Pratique professionnelle, Coût, Qualité, Soin, Canada, Amérique du Nord, Amérique, Evolution, Economie santé, Impact économique, Homme, Chirurgie
Mots-clés Pascal anglais : Endarteriectomy, Carotid, Professional practice, Costs, Quality, Care, Canada, North America, America, Evolution, Health economy, Economic impact, Human, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0504218
Code Inist : 002B25J01. Création : 19/02/1999.