Abstract
Objective: To evaluate the safety and cost effectiveness of carotid surgery performed altering the perioperative protocol in an attempt to decrease resource utilisation. Setting: Department of vascular surgery in a large metropolitan teaching hospital in northern Italy. Design: Prospective, non-selective study. Materials and Methods: Three hundred and eighty carotid procedures were performed in 1995 on 343 patients (274 males, 69 females, mean age 68.2 years, range 47-86 years). The most important cost containment measures were: (i) limiting the use of contrast arteriography to cases of dubious ultrasonic diagnosis; (ii) routine use of loco-regional anaesthesia; (iii) postoperative admission to an intensive care unit (ICU) only in selected cases; (iv) early postoperative discharge where possible. Results: Mortality was 0.26% and neurological morbidity 1.58%. General anaesthesia was required in eight patients (2.1%), and only seven patients (1.8%) were admitted postoperatively to the ICU. Arteriography was performed in 56 cases (14.7%). The average hospital stay was 5 days with a global cost of 43 036 ECU, as compared with a cost of 6764 ECU for patients treated traditionally with routine arteriography, general anaesthesia and routine ICU admission. Conclusions: Selective use of arteriography and ICU, routine use of loco-regional anaesthesia and reduced hospital stay make it possible to lower the cost of carotid surgery without sacrificing quality.
| Original language | English |
|---|---|
| Pages (from-to) | 164-169 |
| Number of pages | 6 |
| Journal | European Journal of Vascular and Endovascular Surgery |
| Volume | 14 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 1997 |
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Keywords
- Carotid artery disease (surgery)
- Cerebrovascular disorders (prevention and control)
- Cost-benefit analysis
- Endarterectomy, carotid
- Health expenditures
- Health resources (utilization)
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Radiology Nuclear Medicine and imaging
- Surgery
Cite this
Safe and cost-effective approach to carotid surgery. / Melissano, G.; Castellano, R.; Mazzitelli, S.; Zoppei, G.; Chiesa, R.
In: European Journal of Vascular and Endovascular Surgery, Vol. 14, No. 3, 1997, p. 164-169.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Safe and cost-effective approach to carotid surgery
AU - Melissano, G.
AU - Castellano, R.
AU - Mazzitelli, S.
AU - Zoppei, G.
AU - Chiesa, R.
PY - 1997
Y1 - 1997
N2 - Objective: To evaluate the safety and cost effectiveness of carotid surgery performed altering the perioperative protocol in an attempt to decrease resource utilisation. Setting: Department of vascular surgery in a large metropolitan teaching hospital in northern Italy. Design: Prospective, non-selective study. Materials and Methods: Three hundred and eighty carotid procedures were performed in 1995 on 343 patients (274 males, 69 females, mean age 68.2 years, range 47-86 years). The most important cost containment measures were: (i) limiting the use of contrast arteriography to cases of dubious ultrasonic diagnosis; (ii) routine use of loco-regional anaesthesia; (iii) postoperative admission to an intensive care unit (ICU) only in selected cases; (iv) early postoperative discharge where possible. Results: Mortality was 0.26% and neurological morbidity 1.58%. General anaesthesia was required in eight patients (2.1%), and only seven patients (1.8%) were admitted postoperatively to the ICU. Arteriography was performed in 56 cases (14.7%). The average hospital stay was 5 days with a global cost of 43 036 ECU, as compared with a cost of 6764 ECU for patients treated traditionally with routine arteriography, general anaesthesia and routine ICU admission. Conclusions: Selective use of arteriography and ICU, routine use of loco-regional anaesthesia and reduced hospital stay make it possible to lower the cost of carotid surgery without sacrificing quality.
AB - Objective: To evaluate the safety and cost effectiveness of carotid surgery performed altering the perioperative protocol in an attempt to decrease resource utilisation. Setting: Department of vascular surgery in a large metropolitan teaching hospital in northern Italy. Design: Prospective, non-selective study. Materials and Methods: Three hundred and eighty carotid procedures were performed in 1995 on 343 patients (274 males, 69 females, mean age 68.2 years, range 47-86 years). The most important cost containment measures were: (i) limiting the use of contrast arteriography to cases of dubious ultrasonic diagnosis; (ii) routine use of loco-regional anaesthesia; (iii) postoperative admission to an intensive care unit (ICU) only in selected cases; (iv) early postoperative discharge where possible. Results: Mortality was 0.26% and neurological morbidity 1.58%. General anaesthesia was required in eight patients (2.1%), and only seven patients (1.8%) were admitted postoperatively to the ICU. Arteriography was performed in 56 cases (14.7%). The average hospital stay was 5 days with a global cost of 43 036 ECU, as compared with a cost of 6764 ECU for patients treated traditionally with routine arteriography, general anaesthesia and routine ICU admission. Conclusions: Selective use of arteriography and ICU, routine use of loco-regional anaesthesia and reduced hospital stay make it possible to lower the cost of carotid surgery without sacrificing quality.
KW - Carotid artery disease (surgery)
KW - Cerebrovascular disorders (prevention and control)
KW - Cost-benefit analysis
KW - Endarterectomy, carotid
KW - Health expenditures
KW - Health resources (utilization)
UR - http://www.scopus.com/inward/record.url?scp=0030805944&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030805944&partnerID=8YFLogxK
U2 - 10.1016/S1078-5884(97)80186-4
DO - 10.1016/S1078-5884(97)80186-4
M3 - Article
C2 - 9345234
AN - SCOPUS:0030805944
VL - 14
SP - 164
EP - 169
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
SN - 1078-5884
IS - 3
ER -