Cost-effective carotid endarterectomy
Background: Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit including outcome measures. Methods: A consecutive series of 333 patients admit...
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| Veröffentlicht in: | British journal of surgery 2000-03, Vol.87 (3), p.323-327 |
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| container_title | British journal of surgery |
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| creator | Sandison, A. J. P. Wood, C. H. Padayachee, T. S. Colchester, A. C. F. Taylor, P. R. |
| description | Background:
Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit including outcome measures.
Methods:
A consecutive series of 333 patients admitted over 7 years under a single consultant surgeon were studied. Outcome measures included the rate of perioperative neurological complication of any kind, and death. The length of hospital stay and the number of readmissions within 30 days were recorded prospectively by computerized audit.
Results:
Over the interval of the study, the number of preoperative investigations was reduced; angiography and cerebral computed tomography were reserved for specific indications. The median duration of hospital stay decreased from 7 to 2 days. There was no change in the stroke and death rate (3 per cent) during the study and only two patients required readmission within 30 days.
Conclusion:
Carotid endarterectomy can be performed cost‐effectively using non‐invasive preoperative investigations for the majority of patients. In‐hospital stay has been reduced and the routine use of intensive care replaced by a 2‐h stay in theatre recovery. These changes have been achieved without compromising patient safety. © 2000 British Journal of Surgery Society Ltd |
| doi_str_mv | 10.1046/j.1365-2168.2000.01361.x |
| format | Article |
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Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit including outcome measures.
Methods:
A consecutive series of 333 patients admitted over 7 years under a single consultant surgeon were studied. Outcome measures included the rate of perioperative neurological complication of any kind, and death. The length of hospital stay and the number of readmissions within 30 days were recorded prospectively by computerized audit.
Results:
Over the interval of the study, the number of preoperative investigations was reduced; angiography and cerebral computed tomography were reserved for specific indications. The median duration of hospital stay decreased from 7 to 2 days. There was no change in the stroke and death rate (3 per cent) during the study and only two patients required readmission within 30 days.
Conclusion:
Carotid endarterectomy can be performed cost‐effectively using non‐invasive preoperative investigations for the majority of patients. In‐hospital stay has been reduced and the routine use of intensive care replaced by a 2‐h stay in theatre recovery. These changes have been achieved without compromising patient safety. © 2000 British Journal of Surgery Society Ltd</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1046/j.1365-2168.2000.01361.x</identifier><identifier>PMID: 10718802</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cost Savings ; Cost-Benefit Analysis ; Economy. Management ; Endarterectomy, Carotid - adverse effects ; Endarterectomy, Carotid - economics ; Health and social institutions ; Humans ; Length of Stay - economics ; Medical sciences ; Middle Aged ; Neurosurgery ; Patient Satisfaction ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Skull, brain, vascular surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><ispartof>British journal of surgery, 2000-03, Vol.87 (3), p.323-327</ispartof><rights>2000 British Journal of Surgery Society Ltd</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3820-ecef772cf98b3f2eb62104354bd086da02513d140527008b79ecffaae55ad13a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1365-2168.2000.01361.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1365-2168.2000.01361.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>309,310,314,776,780,785,786,1411,23909,23910,25118,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1288054$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10718802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sandison, A. J. P.</creatorcontrib><creatorcontrib>Wood, C. H.</creatorcontrib><creatorcontrib>Padayachee, T. S.</creatorcontrib><creatorcontrib>Colchester, A. C. F.</creatorcontrib><creatorcontrib>Taylor, P. R.</creatorcontrib><title>Cost-effective carotid endarterectomy</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background:
Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit including outcome measures.
Methods:
A consecutive series of 333 patients admitted over 7 years under a single consultant surgeon were studied. Outcome measures included the rate of perioperative neurological complication of any kind, and death. The length of hospital stay and the number of readmissions within 30 days were recorded prospectively by computerized audit.
Results:
Over the interval of the study, the number of preoperative investigations was reduced; angiography and cerebral computed tomography were reserved for specific indications. The median duration of hospital stay decreased from 7 to 2 days. There was no change in the stroke and death rate (3 per cent) during the study and only two patients required readmission within 30 days.
Conclusion:
Carotid endarterectomy can be performed cost‐effectively using non‐invasive preoperative investigations for the majority of patients. In‐hospital stay has been reduced and the routine use of intensive care replaced by a 2‐h stay in theatre recovery. These changes have been achieved without compromising patient safety. © 2000 British Journal of Surgery Society Ltd</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cost Savings</subject><subject>Cost-Benefit Analysis</subject><subject>Economy. Management</subject><subject>Endarterectomy, Carotid - adverse effects</subject><subject>Endarterectomy, Carotid - economics</subject><subject>Health and social institutions</subject><subject>Humans</subject><subject>Length of Stay - economics</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Patient Satisfaction</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Skull, brain, vascular surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkFFPwjAQxxujEUS_guFBfdu8tus6El90EdQQfVAjb03XXZPhYLgOhW9vJ4g-Ndf7_S93P0L6FEIKUXw5DSmPRcBonIQMAELwNQ1Xe6S7a-yTru_IgHLGO-TIuSl4CgQ7JB0KkiYJsC45TyvXBGgtmqb4xL7RddUUeR_nua4brP13NVsfkwOrS4cn27dHXoe3L-ldMH4a3afX48DwhEGABq2UzNhBknHLMIuZX5eLKMshiXMNTFCe08gvIQGSTA7QWKs1CqFzyjXvkYvN3EVdfSzRNWpWOINlqedYLZ2SMJBx7M_okdMtuMxmmKtFXcx0vVa_h3ngbAtoZ3Rpaz03hfvjmKdE5LGrDfZVlLj-N0a1ntVUtTpVq1O1ntWPZ7VSNw_PQoCPB5t44Rpc7eK6flex5FKot8eRmkAq03QyVGP-Dfk7fc4</recordid><startdate>200003</startdate><enddate>200003</enddate><creator>Sandison, A. J. P.</creator><creator>Wood, C. H.</creator><creator>Padayachee, T. S.</creator><creator>Colchester, A. C. F.</creator><creator>Taylor, P. R.</creator><general>Blackwell Science Ltd</general><general>Wiley</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>200003</creationdate><title>Cost-effective carotid endarterectomy</title><author>Sandison, A. J. P. ; Wood, C. H. ; Padayachee, T. S. ; Colchester, A. C. F. ; Taylor, P. R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3820-ecef772cf98b3f2eb62104354bd086da02513d140527008b79ecffaae55ad13a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cost Savings</topic><topic>Cost-Benefit Analysis</topic><topic>Economy. Management</topic><topic>Endarterectomy, Carotid - adverse effects</topic><topic>Endarterectomy, Carotid - economics</topic><topic>Health and social institutions</topic><topic>Humans</topic><topic>Length of Stay - economics</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Patient Satisfaction</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Skull, brain, vascular surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sandison, A. J. P.</creatorcontrib><creatorcontrib>Wood, C. H.</creatorcontrib><creatorcontrib>Padayachee, T. S.</creatorcontrib><creatorcontrib>Colchester, A. C. F.</creatorcontrib><creatorcontrib>Taylor, P. R.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sandison, A. J. P.</au><au>Wood, C. H.</au><au>Padayachee, T. S.</au><au>Colchester, A. C. F.</au><au>Taylor, P. R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effective carotid endarterectomy</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2000-03</date><risdate>2000</risdate><volume>87</volume><issue>3</issue><spage>323</spage><epage>327</epage><pages>323-327</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background:
Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit including outcome measures.
Methods:
A consecutive series of 333 patients admitted over 7 years under a single consultant surgeon were studied. Outcome measures included the rate of perioperative neurological complication of any kind, and death. The length of hospital stay and the number of readmissions within 30 days were recorded prospectively by computerized audit.
Results:
Over the interval of the study, the number of preoperative investigations was reduced; angiography and cerebral computed tomography were reserved for specific indications. The median duration of hospital stay decreased from 7 to 2 days. There was no change in the stroke and death rate (3 per cent) during the study and only two patients required readmission within 30 days.
Conclusion:
Carotid endarterectomy can be performed cost‐effectively using non‐invasive preoperative investigations for the majority of patients. In‐hospital stay has been reduced and the routine use of intensive care replaced by a 2‐h stay in theatre recovery. These changes have been achieved without compromising patient safety. © 2000 British Journal of Surgery Society Ltd</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>10718802</pmid><doi>10.1046/j.1365-2168.2000.01361.x</doi><tpages>5</tpages></addata></record> |
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| ispartof | British journal of surgery, 2000-03, Vol.87 (3), p.323-327 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Cost Savings Cost-Benefit Analysis Economy. Management Endarterectomy, Carotid - adverse effects Endarterectomy, Carotid - economics Health and social institutions Humans Length of Stay - economics Medical sciences Middle Aged Neurosurgery Patient Satisfaction Public health. Hygiene Public health. Hygiene-occupational medicine Skull, brain, vascular surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases |
| title | Cost-effective carotid endarterectomy |
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