Intensive care after carotid endarterectomy: a prospective evaluation.
BACKGROUND: Through prior investigation we established that only a small minority of patients who undergo carotid endarterectomy (CEA) have a complicated postoperative course requiring an intensive care unit (ICU) stay. An appropriate policy for patient management was established. This study prospectively analyzes the safety and efficacy of this policy. STUDY DESIGN: Patients were transferred directly to a nonmonitored surgical ward, regardless of preoperative comorbidity, if they remained stable from a neurologic and a hemodynamic standpoint during a short (less than three hour) stay in the recovery room. Patients whose status was questionable remained in recovery longer or were transferred to an ICU. RESULTS: One hundred forty-six (79 percent) of 185 patients were transferred safely to a ward. Average length of stay in recovery was one hour 59 minutes. No complications occurred that required a return to the operating suite or a move to an ICU. Most of these patients (88 percent) were discharged within 24 hours of surgery. Thirty-nine (21 percent) patients, each identified in recovery, required intervention or monitoring in an intensive care setting. Fourteen required prolonged, aggressive intravenous treatment of hypertension; 14 had sustained hypotension; three were observed to rule out myocardial infarction, and three had neurologic deficits. Two patients had ventricular arrhythmias, two had wound hematomas, and one patient required reintubation. This group (n = 39) remained in the recovery room two hours 40 minutes on average, spent 20 hours in the ICU, and remained in the hospital 32 hours after CEA. CONCLUSIONS: Most patients who undergo CEA follow a predictably benign postoperative course. Patients are easily identified by a recovery room protocol and approximately 80 percent can avoid ICU costs.