Intensive care is cost-effective in carotid endarterectomy

The purpose of this study was to analyze the utilization, cost profile, and predictors of intensive care unit (ICU) services after carotid endarterect omy. A retrospective medical record review of all patients undergoing isola ted carotid endarterectomy by a vascular surgery service at one university hospital during a 12-month period was performed. Eighty-four patients under going 91 carotid endarterectomies were identified for review. All carotid e ndarterectomy patients at the authors' institution were routinely admitted to an ICU postoperatively. Sixty-five of the 91 patients (71.4%) required I CU interventions, the majority of which were intravenous antihypertensive t herapy. There were no deaths in the group. There was one non-fatal stroke ( 1.1%), and one non;fatal myocardial infarction (1.1%). There were three reo perations (3.3%): two for hematoma and one for a change in neurological sta tus, One patient required reintubation. Five of the six major adverse event s after carotid endarterectomy occurred within 12 hours postoperatively. No preoperative factors predicted a significant risk for complications follow ing carotid endarterectomy. There is no reliable predictor that carotid end arterectomy patients will require postoperative interventions or develop ad verse outcomes. Mandatory intensive care immediately after carotid endarter ectomy upholds high safety standards, avoids the uncertainty df preoperativ e ICU planning, and avoids the high cost of a recovery room stay to determi ne the need for intensive care, In addition, costs may be further reduced a s the ICU length of stay may be decreased if there are no necessary interve ntions or complications after 12 hours of intensive care. (C) 2000 The Inte rnational Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.