CAROTID ENDARTERECTOMY WITH SHORTENED HOSPITAL STAY

Objective: To review the outcome of a consecutive series of patients u ndergoing carotid endarterectomy with a focus on length of stay. Desig n: Retrospective case review. Setting: Six hundred-bed community hospi tal. Patients: During a 40-month period, we performed 266 carotid enda rterectomies. Ages of patients ranged from 49 to 91 years (mean, 71.2 years). Seventy-two percent were hypertensive, 55% were smokers, 24% w ere diabetic, and 22% had symptomatic heart disease. Indications for o peration included asymptomatic stenosis in 48% of patients, transient ischemia attack in 23%, stroke in 24%, and nonhemispheric symptoms in 5%. Outcome Measures: Perioperative complications and conditions precl uding early hospital discharge were noted. In patients discharged with in 48 hours of operation, problems requiring readmission within 30 day s were recorded. Results: Five patients (1.9%) experienced perioperati ve strokes, of which three were permanent and two temporary. There was one perioperative death. Hospital stays ranged from 1 to 9 days (mean , 1.7 days). Sixty-three percent of the patients were discharged withi n 24 hours and 88% within 48 hours of operation. Patients staying in t he hospital more than 48 hours were significantly older (P=.008). Othe r factors did not correlate with length of stay. Readmission was requi red in five patients. Conclusions: Patients having an uneventful cours e following carotid endarterectomy may be safely discharged within 48 hours of operation. Complications occurring after this time are infreq uent and often unpredictable. It is unlikely that lengthening patient stay would decrease or eliminate these complications.