Contemporary predictors of extended postoperative hospital length of stay after carotid endarterectomy

Ho, Karen J.; Madenci, Arin L.; McPhee, James T.; Semel, Marcus E.; Bafford, Richard; Nguyen, Louis L.; Ozaki, C. Keith; Belkin, Michael

doi:10.1016/j.jvs.2013.11.090

Cited by 25 publications

(28 citation statements)

References 30 publications

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“…However when scheduling a patient for CEA, our study demonstrates it is critical to start the operation before noon or they are significantly more likely to require hospitalization beyond post-operative day one as demonstrated by other groups. [3] Finally, we highlighted no difference in LOS between patients with various intra-operative cerebral monitoring, including EEG and routine measurement of stump pressure as seen by other groups. [20]…”

Section: Discussionmentioning

confidence: 79%

“…[3-5] However, we sought to identify opportunities for better pre-operative and discharge planning focusing on modifiable risk factors to shorten LOS and thus improve outcomes. It is hypothesized a number of pre-operative, intra-operative and post-operative factors could be identified and thus modified to reduce the incidence of prolonged LOS in our CEA population.…”

Section: Introductionmentioning

confidence: 99%

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Modifiable Factors Leading to Increased Length of Stay after Carotid Endarterectomy

Mehaffey

LaPar

Tracci

et al. 2017

Annals of Vascular Surgery

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Objective(s) Carotid Endarterectomy (CEA) is a commonly performed vascular operation. Yet, post-operative length of stay (LOS) varies greatly even within institutions. In the present study, the morbidity and mortality, as well as financial impact of increased LOS were reviewed in order to establish modifiable factors associated with prolonged hospital stay. Methods The Society for Vascular Surgery Vascular Quality Initiative database was used to identify all patients undergoing primary CEA at a single institution between 6/1/2011 and 11/28/2014. Pre-operative patient characteristics, intra-operative details, post-operative factors, long-term outcomes and cost data were reviewed using an Institutional Review Board (IRB) approved prospectively collected database. Multivariate analysis was used to determine statistical difference between patients with LOS ≤ 1 day and >1 day. Results Complete 30-day variable and cost data was available for 219 patients with an average follow-up of 12 months. 79 (36%) patients had a LOS > 1 day. Variables determined to be statistically significant predictors of prolonged LOS included pre-operative creatinine (p=0.02) and severe congestive heart failure (p=0.05) with self-pay status (p=0.02) and pre-operative beta-blocker therapy (p=0.04) being protective. Shunt placement (p=0.04), arterial re-exploration and post-operative cardiac (p=0.001) or neurological (p=0.03) complications also resulted in prolonged hospitalization. Specific modifiable risk factors that contributed to increased LOS included operative start time after noon (p=0.04), drain placement (p=0.05), prolonged operative time (101 minutes vs 125 minutes p=0.01), return to the OR (p=0.01), and post-operative hypertension (p=0.02) or hypotension (p=0.04). Of note, there was no difference in LOS associated with technique (conventional vs eversion), patch use (p=0.49), protamine administration (p=0.60), EEG monitoring (p=0.45), measurement of stump pressure (p=0.63), doppler (p=0.36) or duplex (p=0.92). Both hospital charges (p=0.0001) and costs (p=0.0001) were found to be significantly higher in patients with prolonged LOS, with no difference in physician charges (p=.10). Increased LOS after CEA was associated with an increase in 12-month mortality (p=0.05). Conclusions Increased LOS was associated with increased hospital charges, costs, as well as significant morbidity and midterm mortality following CEA. Further, this study highlights several modifiable risk factors leading to increased LOS. Identified factors associated with increase LOS can serve as targets for improving care in vascular surgery.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Modifiable Factors Leading to Increased Length of Stay after Carotid Endarterectomy

Mehaffey

LaPar

Tracci

et al. 2017

Annals of Vascular Surgery

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“…12,14,17,18,22,24e29 There is a higher risk from extensive length of stay in females 19 or of stroke during follow-up in females. 20 Some articles showed that female sex brings no higher risk; however, subpopulation of female patients who have peripheral occlusive disease, diabetes, and coronary disease are at higher risks, whereas for males, diabetes is the only risk.…”

Section: Discussionmentioning

confidence: 99%

Female and Obese Patients Might Have Higher Risk from Surgical Repair of Asymptomatic Carotid Artery Stenosis

Davidović

Končar

Dragaš

et al. 2015

Annals of Vascular Surgery

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“…In addition to the significantly higher risk of mortality with unplanned operations, 21,26 other authors have observed a significant increase in the cost of care and longer hospital LOS 27 for patients undergoing unplanned procedures. In a study by Ho et al, 28 preoperative factors that independently affected extended LOS included female gender, CHF, and chronic obstructive pulmonary disease. All three of these factors were more prominent among SNPH patients in the current study.…”

Section: Discussionmentioning

confidence: 99%

Care of patients undergoing vascular surgery at safety net public hospitals is associated with higher cost but similar mortality to nonsafety net hospitals

Eslami

Rybin

Doros

et al. 2014

Journal of Vascular Surgery

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Contemporary predictors of extended postoperative hospital length of stay after carotid endarterectomy

Cited by 25 publications

References 30 publications

Modifiable Factors Leading to Increased Length of Stay after Carotid Endarterectomy

Modifiable Factors Leading to Increased Length of Stay after Carotid Endarterectomy

Female and Obese Patients Might Have Higher Risk from Surgical Repair of Asymptomatic Carotid Artery Stenosis

Care of patients undergoing vascular surgery at safety net public hospitals is associated with higher cost but similar mortality to nonsafety net hospitals

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