Short stay carotid surgery for veterans: An emerging standard

We have taken the short stay approach to carotid artery surgery to our VA s etting over the past 5 to 6 years. Retrospectively, we reviewed the efficac y and safety of that approach in 201 consecutive carotid operations over th e recent 4-year period (January 1, 1996-December 31, 1999). In 1996 we had already begun the transition to an algorithm to (1) utilize carotid color f low Doppler duplex exams for diagnosis, (2) same-day admission (SDA), (3) i ntensive care unit (ICU) only when deemed medically necessary, and (4) next -day discharge. Results of this approach have been a decrease in the utiliz ation of diagnostic arteriograms and utilization of the ICU from 100% previ ous to the onset of this approach to 17 and 22%, respectively. SDA increase d from 24 to 89%. Mean LOS decreased from 5.13 +/- 0.9 to 1.97 +/- 0.4 days . The percentage of patients completing the algorithm went from 15 to 72%. Stroke and/or death varied from 0 to 3.7% each year and was only 2.4% over the 4-year period. In conclusion, this approach to short stay carotid surge ry in the veteran population has proven both efficacious and safe with resu lts similar to those in university and community practices. (C) 2001 Academ ic Press.