Qualitative Analysis of Length of Stay and Readmission after Carotid Endarterectomy

Abstract

Length of stay (LOS) and readmissions are common measures to evaluate quality of health care. The objective of this study was to evaluate factors related to hospital LOS and readmission within 90days following carotid endarterectomy (CEA) in patients who have not had a stroke. Using a single institution database, patients who underwent CEA for carotid stenosis between 2014 and 2019 were identified. Asymptomatic carotid stenosis (no history of any stroke or transient ischemic attack (TIA) within 6months prior to CEA), and patients who had a TIA without stroke were included. Demographic and perioperative factors were collected. Primary outcomes analyzed were increased LOS (>1day) and readmission within 90days after surgery. There were 125 patients identified who underwent CEA for 133 carotid stenosis, and 8 patients had bilateral CEA; of which 36.8% were asymptomatic carotid stenosis with the remaining being operated on for TIA without any stroke. The mean age was 68years old and 36.1% of cases were female. The median postoperative LOS was 2days. Increased LOS occurred in 81 cases (60.9%). Increased LOS, compared to no increased LOS, occurred more often in patients with diabetes (48.1% vs. 30.8%, P=0.047), in those with operations starting after 12:00 pm (45.7% vs. 21.2%, P=0.004) and those with any minor complications such as neck swelling, neck pain, and urinary retention (30.9% vs. 15.4%, P=0.044). Readmission within 90days after CEA occurred in 24 (18%) of cases. Readmission within 90days, compared to no readmission within 90days, occurred more often in patients with a history of coronary artery disease (58.3% vs. 27.5%, P=0.004), congestive heart failure (37.5% vs. 11%, P=0.001), and atrial fibrillation (29.2% vs. 8.3%, P=0.004). More than half of patients undergoing CEA for carotid stenosis were discharged after postoperative day 1. Interventions on modifiable clinical risk factors, such as morning CEA scheduling and management of comorbidities, may decrease LOS and 90-day readmission rates.