Po. Daily et al., COST REDUCTION BY COMBINED CAROTID ENDARTERECTOMY AND CORONARY-ARTERYBYPASS-GRAFTING, Journal of thoracic and cardiovascular surgery, 111(6), 1996, pp. 1185-1192
A significant cost reduction is likely if patients who require coronar
y artery bypass grafting with significant carotid stenosis have simult
aneous carotid endarterectomy and bypass grafting, provided risk is no
t increased. To investigate this issue, we retrospectively identified
cases from February 1977 to May 1994 with first-time isolated carotid
endarterectomy, coronary bypass, or combined procedures. In the isolat
ed carotid endarterectomy population, median age was 69 years and 58%
(85/146) were male, as compared with 68 years and 68% (68/100) male in
the combined group; median age of the coronary bypass cohort was 65 y
ears and 76% (381/500) male. A significantly higher percentage of pati
ents in the coronary bypass versus combined group were in New York Hea
rt Association functional class IV. In the combined group there was a
significantly higher incidence of older age, diabetes, hypertension, h
yperlipidemia, renal failure, and congestive heart failure. There was
no difference among the three groups with respect to hospital mortalit
y (0%, 3.4%, and 4.0%, respectively) and permanent stroke (0.7%, 1.2%,
and 0%, respectively). Hospital costs were $4,896, $10,959 and $11,08
9, respectively, with a savings of $4,766 (30%), and Medicare hospital
reimbursement was $8,575, $23,071, and $23,071, respectively, with a
savings of $10,077 (25.3%). Thus, in appropriate patients, a combined
procedure is cost effective, eliminating a second surgical procedure a
nd the cost of the postoperative stay (3.7 +/- 2.4 days) associated wi
th isolated carotid endarterectomy. Risk of permanent stroke or death
is not increased.