Feasibility and Safety of 1-Day Postoperative Hospitalization for Carotid Endarterectomy

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Abstract
Objective: To determine whether 1-day postoperative hospitalization after carotid endarterectomy is safe and the degree to which this can be achieved. Design: Consecutive sample series of all carotid endarterectomies performed by a single surgical group. Setting: A single tertiary-care hospital. Patients: All who underwent carotid endarterectomy. Patients with procedures combined with coronary revascularization and patients undergoing the first part of a staged bilateral carotid endarterectomy performed in 1 hospitalization were excluded. Intervention: In December 1993, a fast-track protocol was initiated, aiming for a 1-day stay after carotid endarterectomy without admission to an intensive care unit (ICU). Before this date, postoperative care included obligatory monitoring for at least 1 night in an ICU. Main Outcome Measures: Length of stay, admission to and stay in the ICU, complications, and hospital readmission rate. Results: Over a 21-month period, 152 patients had 163 carotid endarterctomies. Of these, 124 were elective and 39 urgent (patients with a critical stenosis). Indications were stroke (n=14 [8.6%]), transient ischemic attack (n=50 [30.7%]), amaurosis fugax (n=36 [22.1%]), and asymptomatic stenosis (n=63 [38.7%]). General anesthesia was used for 159 procedures, cervical block for 4. Mean operation time was 2.6 hours. Postoperative stay was 1 day for 82 procedures (50%), 2 days for 49 procedures (30%), 3 days for 12 procedures (7%), and longer for 20 procedures (12%). In the last half of the study, 61% of patients (50/82) were discharged on postoperative day 1 and 87% (71/82) by postoperative day 2. One hundred three patients went to a surgical floor postoperatively. Overall, 60 patients went to the ICU, but only 18 (22%) of the last 82 procedures required ICU admission. The total stay averaged 3.8 days. Twenty-one patients (13%) experienced complications, including 3 deaths within 30 days and 5 neurological deficits. There were 14 early readmissions, but none was attributable to discharge on the first or second postoperative day. Conclusions: Early discharge home after carotid endarterectomy is safe and efficacious, and obligatory admission to an ICU is not necessary. At least 60% of patients who undergo carotid endarterectomy can have a postoperative stay of 1 day, and more than 80% can be discharged by postoperative day 2. A short postoperative stay is not associated with a significant risk of readmission for complications. Arch Surg. 1996;131:751-755