Discharge on the First Postoperative Day after Elective Carotid Endarterectomy

BACKGROUND:

Medical complications may prolong the hospital stay after elective carotid endarterectomy (CEA). We prospectively assessed the social and medical feasibility and safety of patient discharge on the first postoperative day after elective CEA, as well as unplanned readmissions.

METHODS:

From June 2011 to January 2012, 57 consecutive patients scheduled for elective CEA were enrolled with the aim of discharge on the first postoperative day if there were no medical contraindications and on the condition that the patient should not be left alone during the first day and night at home. CEA was carried out under local or general anaesthesia. After discharge the patients were contacted to ascertain the occurrence of arterial hypertension, cerebral hyperperfusion, focal cerebral ischaemia or hospital readmission.

RESULTS:

Sixty-two CEA were carried out in 57 patients, 33 male and 24 female, aged 51 to 89 years. The indications for CEA were: asymptomatic high grade stenosis in 27, hemispheric transient ischaemic attack in 12, amaurosis fugax in 6, recovered stroke in 16 and non-lateralising signs in one. There were no cases of perioperative stroke or death. Discharge on the first postoperative day was achieved in 45 cases (73%). In 15 cases (24%) discharge was on the second postoperative day because of the absence of a relative (12 cases) or because of medical reasons (3 cases). Discharge was on day 3 in one case, and on day 10 in another, both because of medical reasons. No cases of severe arterial hypertension, stroke or mortality, or readmission for reasons related to the CEA procedure were recorded up to the 30th postoperative day.

CONCLUSION:

In this study, the majority of patients undergoing elective CEA were discharged safely on the first postoperative day. Social reasons, rather than medical reasons, underlied most cases of later discharge. There were no unplanned readmissions for complications of CEA.