Case management in cerebral revascularization.
OBJECTIVE
We examined the clinical and financial outcomes of case management coupled with the initiation of selective use of the intensive care unit (ICU) in all cerebral revascularization procedures.


METHODS
Three hundred eighty-four procedures in 331 patients were retrospectively reviewed. Morbidity and mortality rates, hospital length of stay, cost, and ICU or hospital readmissions were examined. Hypertension was examined as an independent variable for its effect on patient outcome.


RESULTS
Cerebral revascularization, including carotid endarterectomy, vertebral-carotid artery transposition, and subclavian-carotid artery transposition, yielded a 0.78% stroke rate and 0.26% perioperative death rate in this series. ICU admission was necessary in nine patients (2.3%) for cardiac or respiratory instability. Three patients (0.78%) required transfer to the ICU for management of hypertension or hypotension. The mean hospital length of stay after institution of case management was reduced by 2.1 days, and the mean cost was decreased by $1987, a savings of 28.9% of total hospital cost.


CONCLUSIONS
The dual approach of case management and selective use of the ICU promotes quality patient care, conserves financial resources without adversely affecting morbidity or mortality rates, enhances physician/nurse collaboration, and improves patient satisfaction.
Hoyle
R M
RM
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
Jenkins
J M
JM
Edwards
W H
WH
Edwards
W H
WH
Martin
R S
RS
Mulherin
J L
JL
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000191:economics / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000191:economics / Q000379:methods*; D002548:Cerebral Revascularization / Q000191:economics / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D016894:Endarterectomy, Carotid / Q000191:economics / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009543:Nifedipine / Q000627:therapeutic use; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013348:Subclavian Artery / Q000601:surgery
D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D009543:Nifedipine