CVA1 Economic Outcomes of Carotid Endrterectomy for Stroke

Abstract

American Heart Association Guidelines establish acceptable limits of carotid endarterectormy (CEA) postoperative morbidity/mortality at 7–9%. Based on these standard, early CEA (within 30 days of non-disabling stroke) has been safely performed. However, early CEA is not standard practice at many institutions. Decreasing the interval between stroke and surgery (SSI) may decrease the risk of recurrent stroke in the SSI and resource utilization through elimination of interval anticoagulation. OBJECTIVE: Clinical and economic outcomes of early and delayed (beyond 30 days) CEA in non-disabling stroke patients were examined. METHODS: Sixty-three patients were identified through a physician's office registry, the Thomas Jefferson University Hospital's clinical financial management system, and chart review as having had CEA for non-disabling stroke between November, 1991 and December, 1996. Details regarding SSI and perioperative (surgery to discharge) stroke, myocardial infarction (MI), and death were obtained from charts. Inpatient costs were extracted from clinical financial management systems for early and delayed group patients. Interval anticoagulation costs were estimated using established models in atrial fibrillation. RESULTS: Early Patients (n=43) Delayed Patients (n=20) % > 2 comorbidities 63% (27) 37% (7) Perioperative stroke rate 2.3% (1) 5% (1) MI/Death rate 0% (0) 5% (1) The average total cost of hospitalization per delayed group patient was $US11,337 (95% CI $9,217–$13,943). The cost of initial hospitalization and interval anticoagulation per delayed group patient was estimated to be $US3,119. The estimated total cost of treatment per patient in the early and delyed groups, respectively, was $US13,791 and $US14,455. CONCLUSION: This study suggests that early CEA can be performed with acceptable perioperative morbidity rates in selected non-disabling stroke patients. Decreasing the length of the SSI decreases the recurrent stroke risk and interval anticoagulation resource utilization.