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
The Johns Hopkins Hospital, Baltimore, MD, USA.
The Johns Hopkins Hospital, Baltimore, MD, USA.
Am J Surg. 2025 Jan;239:116056. doi: 10.1016/j.amjsurg.2024.116056. Epub 2024 Nov 10.
This study investigated the outcomes before and after initiation of a postoperative care pathway for carotid endarterectomy (CEA) patients.
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.
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).
Initiation of a CEA pathway was associated with lower ICU rates and reduction in hospital charges without compromising patient outcomes.
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。
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）。
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）。
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。
