Safe and cost-effective approach to carotid surgery

G. Melissano, R. Castellano, S. Mazzitelli, G. Zoppei, R. Chiesa

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)164-169
Number of pages6
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume14
Issue number3
DOIs
Publication statusPublished - 1997

Fingerprint

Intensive Care Units
Angiography
Costs and Cost Analysis
Conduction Anesthesia
General Anesthesia
Length of Stay
Cost Control
Urban Hospitals
Teaching Hospitals
Italy
Cost-Benefit Analysis
Blood Vessels
Ultrasonography
Morbidity
Safety
Mortality

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 journalArticle

Melissano, G. ; Castellano, R. ; Mazzitelli, S. ; Zoppei, G. ; Chiesa, R. / Safe and cost-effective approach to carotid surgery. In: European Journal of Vascular and Endovascular Surgery. 1997 ; Vol. 14, No. 3. pp. 164-169.
@article{835cded04823441b9873ee5f14b48e9d,
title = "Safe and cost-effective approach to carotid surgery",
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.",
keywords = "Carotid artery disease (surgery), Cerebrovascular disorders (prevention and control), Cost-benefit analysis, Endarterectomy, carotid, Health expenditures, Health resources (utilization)",
author = "G. Melissano and R. Castellano and S. Mazzitelli and G. Zoppei and R. Chiesa",
year = "1997",
doi = "10.1016/S1078-5884(97)80186-4",
language = "English",
volume = "14",
pages = "164--169",
journal = "European Journal of Vascular and Endovascular Surgery",
issn = "1078-5884",
publisher = "W.B. Saunders Ltd",
number = "3",

}

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 -