标准化的颈动脉内膜切除术护理路径与较低的重症监护病房（ICU）入住率及显著降低的住院费用相关。
A standardized carotid endarterectomy care pathway is associated with lower ICU admission rates and a significant reduction in hospital charges.
作者信息
Grunebach Holly, Madeira Timothy, Bose Sanuja, Holscher Courtenay, Aru Roberto G, Abularrage Christopher J, Black James H, Lum Ying Wei, Perler Bruce A, Hicks Caitlin W
机构信息
The Johns Hopkins Hospital, Baltimore, MD, USA.
The Johns Hopkins Hospital, Baltimore, MD, USA.
出版信息
Am J Surg. 2025 Jan;239:116056. doi: 10.1016/j.amjsurg.2024.116056. Epub 2024 Nov 10.
BACKGROUND
This study investigated the outcomes before and after initiation of a postoperative care pathway for carotid endarterectomy (CEA) patients.
METHODS
A CEA pathway was developed with stakeholders. We compared in-hospital outcomes and charges (USD) for patients undergoing CEA 18 months before (11/2019-04/2021) vs. after (05/2021-11/2022) implementation.
RESULTS
149 patients (mean age 70.2 ± 10.9 years, 60.4 % male, 75.7 % white) underwent CEA (83 pre-initiative, 66 post-initiative). There was significant reduction in intensive care unit (ICU) care (90.4 % vs.46.2 %; P < 0.001) but no changes in stroke (3.6 % vs. 0 %), death (0 % vs. 0 %), or median length-of stay (1.0 vs. 1.0 days) following implementation (all, P > 0.12). After risk adjustment, the pathway was associated with charge reductions of $1631/patient/day (95%CI -$3,008, -$254).
CONCLUSIONS
Initiation of a CEA pathway was associated with lower ICU rates and reduction in hospital charges without compromising patient outcomes.
背景
本研究调查了颈动脉内膜切除术（CEA）患者术后护理路径启动前后的结果。
方法
与利益相关者共同制定了CEA路径。我们比较了实施CEA之前（2019年11月至2021年4月）和之后（2021年5月至2022年11月）患者的住院结果和费用（美元）。
结果
149例患者（平均年龄70.2±10.9岁，60.4%为男性，75.7%为白人）接受了CEA手术（83例在路径启动前，66例在路径启动后）。实施后，重症监护病房（ICU）护理显著减少（90.4%对46.2%；P<0.001），但中风（3.6%对0%）、死亡（0%对0%）或中位住院时间（1.0天对1.0天）没有变化（所有P>0.12）。经过风险调整后，该路径与每位患者每天减少1631美元的费用相关（95%CI -3008美元，-254美元）。
结论
启动CEA路径与较低的ICU使用率和医院费用降低相关，且不影响患者预后。
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