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.
  
  
  METHODS
  Department of vascular surgery in a large metropolitan teaching hospital in northern Italy.
  
  
  METHODS
  Prospective, non-selective study.
  
  
  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 ultrasonographic 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.
authors.affiliation: Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Milano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Melissano
authors.forename: R
authors.initials: R
authors.lastname: Castellano
authors.forename: S
authors.initials: S
authors.lastname: Mazzitelli
authors.forename: G
authors.initials: G
authors.lastname: Zoppei
authors.forename: R
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction / Q000191:economics / Q000706:statistics & numerical data; D002533:Cerebral Angiography / Q000191:economics / Q000706:statistics & numerical data; D003363:Cost Control; D003362:Cost-Benefit Analysis; D016894:Endarterectomy, Carotid / Q000191:economics* / Q000379:methods; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies