CONSERVING RESOURCES AFTER CAROTID ENDARTERECTOMY - SELECTIVE USE OF THE INTENSIVE-CARE UNIT

A retrospective review was undertaken of a random sample (N = 73) comprising 50% of carotid endarterectomies performed during 1986 to evaluate the necessity of routine postoperative intensive care unit (ICU) admission after carotid endarterectomy. Severity of illness was determined with use of the Acute Physiology Score of the APACHE II system. The Therapeutic Index Scoring System was used to quantify postoperative services used. Postoperative morbidity was analyzed. Financial impact was extrapolated with use of 1990 billing data. Length of ICU stay was 24.5 hours. Only 13 of 73 patients (18%) required ICU services. In 10 (77%) of these patients therapy was initiated in the recovery room and discontinued in six patients within 3 hours of ICU admission. Only two patients required ICU services for 16 hours after surgery. The mean Acute Physiology Score was low (4.96) and could not identify patients who required unique ICU services. Neurologic deficits were seen in five patients (6.9%). In three cases deficits were recognized in the recovery room; deficits developed in two patients after discharge from the ICU. Observation in the recovery room with transfer of stable patients would have eliminated ICU admission in 60 patients (82%). In 1990 the incremental ICU charge was $720/patient day. This represents 12.5% of the hospital charges for carotid endarterectomy. The ICU is an expensive and highly used hospital resource. Only a few patients need unique ICU services after carotid endarterectomy, and this is usually apparent within 2 hours of surgery. Prolonged recovery room observation or use of intermediate care units can avoid ICU admission for most patients undergoing carotid endarterectomy thereby conserving this precious hospital resource.