Short Stay Carotid Surgery for Veterans: An Emerging Standard

• Published in: The Journal of surgical research Vol. 95; no. 1; pp. 32 - 36
• Main Authors: Littooy, F.N., Steffen, G., Greisler, H.P., Kang, S.S., Mansour, M.A., Chmura, C.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.01.2001; Elsevier
• Subjects: Aged; Biological and medical sciences; Carotid Arteries - surgery; carotid surgery; Economy. Management; Female; Health and social institutions; Humans; Intensive Care Units; Length of Stay; Male; Medical sciences; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; short stay; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Veterans; standard; veterans; short stay; carotid surgery; Human; Economy; Treatment; Carotid; Surgery; Duration; Hospitalization; Bibliographic review; Retrospective; Public health
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1006/jsre.2000.6034

We have taken the short stay approach to carotid artery surgery to our VA setting over the past 5 to 6 years. Retrospectively, we reviewed the efficacy and safety of that approach in 201 consecutive carotid operations over the 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 flow Doppler duplex exams for diagnosis, (2) same-day admission (SDA), (3) intensive care unit (ICU) only when deemed medically necessary, and (4) next-day discharge. Results of this approach have been a decrease in the utilization of diagnostic arteriograms and utilization of the ICU from 100% previous to the onset of this approach to 17 and 22%, respectively. SDA increased 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 surgery in the veteran population has proven both efficacious and safe with results similar to those in university and community practices.