Cost-efficient carotid surgery: A comprehensive evaluation

Purpose: This study was performed to determine whether comprehensive cost-cutting strategies adversely affect the outcome in patients undergoing carotid endarterectomy. Methods: From December 1994 to December 1995, 237 consecutive patients undergoing 260 carotid endarterectomies were prospectively studied. The following variables were assessed: carotid arteriography, preoperative laboratory tests, electrocardiograms and chest x-ray films, use of carotid shunts during operation, use of pathology department, intensive cart, oxygen therapy, telemetry, and hospital stay. In addition, complications were tabulated. Results: Previously, ail variables evaluated were routinely ordered. Subsequent to initiating the cost-containment strategies, the following results were achieved:arteriography in 52 (22%) of 237 patients, preoperative complete blood cell count and SMA-7 in 161 (62%) of 260 cases, preoperative electrocardiograms in 185 (71%) of 260 cases, preoperative chest x-ray films in 190 (73%) of 260 cases, carotid shunts in 83 (32%) of 260 cases, disease in no cases (0%), intensive care in 29 (11%) of 260 cases, oxygen therapy in 34 (13%) of 260 cases, telemetry in 17(7%) of 260 cases, and hospital stay was decreased from an average of 2.6 to 1.3 days. Total savings based on average hospital and physician charges was $2.3 million. Complications included four strokes, one myocardial infarction, and no deaths. No patient required readmission. No recurrent or new neurologic or cardiac findings were identified clinically in follow-up at I and 4 weeks after surgery. Conclusions: The results clearly demonstrate that comprehensive cost-cutting strategies can reduce charges significantly while maintaining patient safety.