title: Uncomplicated carotid endarterectomy: factors contributing to blood pressure instability precluding safe early discharge.
abstract: This study was undertaken to identify preoperative and intraoperative factors that correlate with the need for postoperative vasoactive medication (VM) use. Clinical data from 100 carotid endarterectomies (CEAs) performed in 93 patients were reviewed. Baseline comorbidities, medications, perioperative physiologic data, and operative technique were evaluated for their association with the need for postoperative VM use. Statistical analysis included univariate and multivariate logistic regression with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Hemodynamic instability affected 43 patients, of whom 32 had VM started in the postanesthesia care unit (PACU). No patient who was hemodynamically stable in the PACU later required VM. The only preoperative factor associated with a need for postoperative VM was a prior stroke (OR 4.5; 95% CI 1.2-16.2; p = .02). Intraoperative factors associated with the need for postoperative VM included use of a shunt (OR 5.1; 95% CI 1.2-22.2; p = .03) and a peak intraoperative systolic blood pressure greater than 200 mm Hg (OR 5.1; 95% CI 1.2-22.2; p = .03). The number and type of preoperative blood pressure medications, preoperative hypertension, comorbidities, symptomatic presentation, and intraoperative use of VM did not correlate with postoperative VM use. There were two strokes and no deaths. Patients undergoing CEA who are hemodynamically stable in the PACU appear to be reasonable candidates for same-day discharge and warrant further prospective study.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Posner
authors.forename: Leslie
authors.initials: L
authors.lastname: Boxer
authors.forename: Mary
authors.initials: M
authors.lastname: Proctor
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.forename: James C
authors.initials: JC
authors.lastname: Stanley
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000008:administration & dosage; D003365:Costs and Cost Analysis; D003422:Critical Care; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000191:economics; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010351:Patient Discharge; D018579:Patient Selection; D011182:Postoperative Care; D012307:Risk Factors; D020521:Stroke / Q000150:complications
chemical_list: D002317:Cardiovascular Agents