Cost-effective carotid endarterectomy

Background: Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit incl uding outcome measures. Methods: A consecutive series of 333 patients admitted over 7 years under a single consultant surgeon were studied. Outcome measures included the rate of perioperative neurological complication of any kind, and death. The len gth of hospital stay and the number of readmissions within 30 days were rec orded prospectively by computerized audit. Results: Over the interval of the study, the number of preoperative investi gations was reduced; angiography and cerebral computed tomography were rese rved for specific indications. The median duration of hospital stay decreas ed from 7 to 2 days. There was no change in the stroke and death rate (3 pe r cent) during the study and only two patients required readmission within 30 days. Conclusion: Carotid endarterectomy can be performed cost-effectively using non-invasive preoperative investigations for the majority of patients. In-h ospital stay has been reduced and the routine use of intensive care replace d by a 2-h stay in theatre recovery. These changes have been achieved witho ut compromising patient safety.