Title

Factors that determine the length of stay after carotid endarterectomy represent opportunities to avoid financial losses

UMMS Affiliation

Department of Surgery, Division of Vascular and Endovascular Surgery

Publication Date

2014-10-01

Document Type

Article

Subjects

Aged; Carotid Artery Diseases; Diagnosis-Related Groups; Economics, Hospital; Elective Surgical Procedures; *Endarterectomy, Carotid; Female; Follow-Up Studies; Hospital Costs; Hospitals; Humans; Length of Stay; Male; New England; Postoperative Complications; Postoperative Period; Retrospective Studies

Disciplines

Cardiovascular Diseases | Health and Medical Administration | Surgery

Abstract

BACKGROUND: A postoperative length of stay (LOS) > 1 day after elective surgery incurs financial losses for hospitals, given fixed diagnosis-related group-based reimbursement. We sought to identify factors leading to a prolonged LOS ( > 1 postoperative day) after carotid endarterectomy (CEA).

METHODS: Patients undergoing CEA in 23 centers of the Vascular Study Group of New England between 2003 and 2011 (n = 8860) were analyzed. Only elective, primary CEAs were analyzed, leaving a study cohort of 7108 procedures. Hierarchical multivariable logistic regression analysis was performed to identify predictors of a postoperative LOS > 1 day. A Knaus-Wagner chi-pie analysis was performed to determine the relative contributions of each significant covariate to a postoperative LOS > 1 day.

RESULTS: A postoperative LOS > 1 day occurred in 17.5% of the sample (n = 1244). The average LOS was 1.4 days (range, 1-91 days; median, 1). There was significant variation in rates of postoperative LOS > 1 day across centers (range, 5%-100%; P < .001). Factors independently associated with a postoperative LOS > 1 day and their percentage contribution to the prediction model included the need for postoperative intravenous medications for hypertension or hypotension (26%), any major adverse event (MAE) postoperatively (21%), low-volume ( < 15 CEAs per year) surgeons (28%), increasing age (7%), female gender (4%), positive result on a preoperative stress test (3%), preoperative major stroke < / = 30 days (2%), medication-dependent diabetes (1%), severe chronic obstructive pulmonary disease (1%), history of congestive heart failure (1%), and CEA performed on Friday (2%).

CONCLUSIONS: Certain patient characteristics predispose to a postoperative LOS > 1 day after elective CEA. However, patient characteristics play only a modest (17%) role in determining LOS. The need for postoperative blood pressure control and MAEs are the biggest drivers of postoperative LOS > 1 day, but system factors, such as low operative volume, contribute substantially to postoperative LOS > 1 day, independent of MAEs. These findings can be used to guide quality improvement efforts designed to reduce LOS after elective CEA.

DOI of Published Version

10.1016/j.jvs.2014.03.292

Source

J Vasc Surg. 2014 Oct;60(4):966-72.e1. doi: 10.1016/j.jvs.2014.03.292. Epub 2014 May 24. Link to article on publisher's site

Journal/Book/Conference Title

Journal of vascular surgery

Related Resources

Link to Article in PubMed

PubMed ID

24865784

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