Fast tracking carotid endarterectomy: practical considerations.

The diagnosis-related groups (DRG) and managed care economics have encouraged physicians to be more cost and resource efficient. In response to this demand, a fast track program for elective carotid endarterectomies has been established at Sewickley Valley Hospital. The essential components of this four-step program are operation based on duplex ultrasonography alone, same-day admission, a short recovery room stay to limit intensive care use, and discharge on the first postoperative day. Overall, 79% of patients for elective carotid endarterectomy successfully completed all four steps of the protocol at our institution. This has resulted in marked cost savings.