Comparison of short-term clinical postoperative outcomes in patients who underwent carotid endarterectomy: intensive care unit versus the ward high-dependency unit.

Abstract

The objective of this research was to examine the routine postoperative management of patients who have undergone carotid endarterectomy and compare the intensive care unit (ICU) with the ward high-dependency unit (HDU) in terms of the number, type, severity, or management of postoperative clinical events within a 48-hour time frame. Two of the vascular surgeons routinely admitted patients to the ICU, and 1 vascular surgeon routinely admitted patients to the ward HDU. This research determines whether there was a difference in outcomes between the 2 groups with the intention of changing the practice of the 2 vascular surgeons who routinely admitted their patients to the ICU. This was a nonexperimental, descriptive, prospective study of all patients who underwent carotid endarterectomy during an 18-month period between August 1999 and January 2000. A total of 104 patients were recruited to the study. There were 84 patients in the ICU cohort; 59 were male and 25 were female, with a mean age of 72 years. There were 20 patients in the ward HDU cohort; 12 were male and 8 were female, with a mean age of 66 years. Major complications occurred in 3 patients. One patient from the ICU group was returned to the operating room for evacuation of a hematoma, and 2 patients from the ward HDU group were transferred to the ICU for an inotropic infusion. During the first 24 hours, hypertension developed in 37 patients in the ICU cohort, 12 of whom did not require intervention. Hypertension requiring intervention developed in 3 patients in the ward group. Chi-square cross-tabulation revealed a chi 2 value of 1.4 and a P value of.01, which is a significant difference in the number of hypertensive events in the ICU versus the ward HDU. Hypotension occurred in 41 patients in the ICU group and in 9 patients in the ward cohort. The same chi 2 test was used to reveal a chi 2 value of 0.026 and a P value of.87, which are nonsignificant results. There was no difference in the number of hypotensive events in the ICU versus the ward HDU. There were no reported incidents of tachycardia. Bradycardia was reported in 64 patients in the ICU group and in 12 patients in the HDU group. There was no significant difference in the number of patients with bradycardia in either group of patients. Chi-square analysis revealed a chi 2 value of 1.4 and a P value of.23 during the first 24 hours postoperatively. We believe that careful selection of patients to the ward HDU is safe and cost-effective.