title: Factors related to short length of stay after carotid endarterectomy.
abstract: In the past decade, expected in-hospital length of stay (LOS) after carotid endarterectomy (CEA) has decreased from 4 days to 1. Long LOS is associated with known complications and factors affecting severity of the patient's condition. Factors affecting an intermediate stay of 2 to 4 days need further clarification. The vascular registry at Jobst Vascular Center includes data on manifestation of disease; cardiovascular history; operation and discharge dates; surgeon; surgical details such as patching, shunting, and completion arteriography; and complications. Univariate chi-square and ANOVA and multivariate logistic regression were applied to analyze 635 CEAs performed in 1998, 1999, and 2000. Statistical significance was at a p value less than 0.05 (two-sided). Overall morbidity rate was 8.2% with three (0.5%) in-hospital neurologic complications and one death for a 0.16% mortality rate. Fifty-eight percent of the patients were discharged in 1 day. Patients staying 1 day were 3 years younger. Female gender and prior cerebrovascular accident were factors extending LOS to 2 and 3 days. History of angina, heart failure, valve disease, and vein patch or no patch contributed to LOS of 3 or 4 days. Completion arteriography had an association with LOS of 2 days. The relative percentage of patients with complications increased with LOS. No significant relationship was found for symptoms, smoking, myocardial infarction, atrial fibrillation, cardiac revascularization, or surgeon. Insulin-treated diabetes mellitus, cardiac risk factors, cerebrovascular accident, and vein patch or no patch correlated with prolonged hospitalization. Factors were identified that may alter a clinical pathway designed for discharge 1 day after CEA. Focused management of patients with cardiac and cerebrovascular accident history or requiring vein patch and a better understanding of CEA in women may further increase the percentage of patients discharged 1 day after CEA.
authors.affiliation: Jobst Vascular Center, Toledo, OH 43606, USA.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Hernandez
authors.forename: Sergio X
authors.initials: SX
authors.lastname: Salles-Cunha
authors.forename: Yahya A H
authors.initials: YA
authors.lastname: Daoud
authors.forename: Steven M
authors.initials: SM
authors.lastname: Dosick
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Whalen
authors.forename: John P
authors.initials: JP
authors.lastname: Pigott
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Seiwert
authors.forename: Todd E
authors.initials: TE
authors.lastname: Russell
authors.forename: Hugh G
authors.initials: HG
authors.lastname: Beebe
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D012737:Sex Factors