Carotid endarterectomy: The financial impact of practice changes

Purpose: New techniques in the management of extracranial carotid occlusive disease have focused attention on the outcome and economics of carotid end arterectomy (CEA). Changing practice patterns for CEA must be assessed to a llow accurate comparisons. The purpose of this study was to evaluate the ef fect of practice modifications related to CEA on patient outcome and cost d ata. Methods: Data on patients undergoing CEAs at a single institution from fisc al year 1992 to 1998 were prospectively collected and entered into a comput erized database. Records were reviewed for patient demographics and outcome with regard to stroke and death. Selected years that corresponded to trans itions in perioperative management were audited for complete hospital finan cial information from. Results: We performed 960 CEAs during the study period, with a combined str oke and death rate of 1.1%. Inflation-adjusted hospital costs per patient i n 1998 dollars for the years 1992, 1996, and 1998 were $5494, $4476, and $3 350, respectively. In 1998, costs for patients who required arteriography w ere $1825 greater than those operated on during duplex scan examination alo ne in 1998. Statistically significant differences occurred in the year-to-y ear comparisons in the use of arteriography, intensive care unit monitoring , same day admissions, and length of stay. There were no statistically sign ificant differences in the stroke and death rate between years. Conclusion: Practice changes related to CEA have resulted in significant sa vings without detriment in patient outcome. Comparisons between CEA and end ovascular techniques will need to be evaluated within this context. Given t hese advances in perioperative management, it will be difficult to justify carotid stenting on the basis of current economic considerations.