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Van den Brande P, Van Heymbeeck I, Debing E, Aerden D, von Kemp K, Moerman L, Verborgh C, Haentjens P. Discharge on the first postoperative day after elective carotid endarterectomy. Ann Vasc Surg 2013; 28:901-7. [PMID: 24362259 DOI: 10.1016/j.avsg.2013.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/20/2013] [Accepted: 10/06/2013] [Indexed: 10/25/2022]
Abstract
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 and unplanned readmissions. METHODS Between June 2011 and 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 anesthesia. After discharge, the patients were contacted to ascertain the occurrence of arterial hypertension, cerebral hyperperfusion, focal cerebral ischemia, or hospital readmission. RESULTS Sixty-two CEA were carried out in 57 patients (33 men and 24 women ranging in age from 51-89 years). The indications for CEA were: asymptomatic high grade stenosis in 27, hemispheric transient ischemic attack in 12, amaurosis fugax in 6, recovered stroke in 16, and nonlateralizing signs in 1. 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 for medical reasons (3 cases). Discharge was on day 3 in 1 case, and on day 10 in another, both for medical reasons. No cases of severe arterial hypertension, stroke, mortality, or readmission for reasons related to the CEA procedure were recorded up to postoperative day 30. 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.
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Affiliation(s)
| | - Isolde Van Heymbeeck
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Erik Debing
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Dimitri Aerden
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Karl von Kemp
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Leslie Moerman
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Chris Verborgh
- Department of Anesthesiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Patrick Haentjens
- Center for Outcome Research, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Randall MS, McKevitt FM, Kumar S, Cleveland TJ, Endean K, Venables GS, Gaines PA. Long-Term Results of Carotid Artery Stents to Manage Symptomatic Carotid Artery Stenosis and Factors That Affect Outcome. Circ Cardiovasc Interv 2010; 3:50-6. [DOI: 10.1161/circinterventions.108.828335] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Limited data are available about the long-term outcomes of the use of carotid artery stents in symptomatic patients and the impact of patient variables on the durability of endovascular carotid procedures. Outcome data previously reported from registry series mix symptomatic and asymptomatic patients. We present analysis of long-term follow-up, with independent neurological assessment, for patients with symptomatic high-grade carotid lesions undergoing stenting to identify patients at risk of recurrence.
Methods and Results—
Prospectively collected data on 563 carotid stenting procedures in a single center were analyzed. Univariate and multivariate techniques were used to identify risk groups and beneficial technical adaptations. Ipsilateral stroke rates for all patients were 4.8%, 7.0%, and 9.5% at 30 days, 1 year, and 4 years, respectively. The rates improved to 2.7%, 4.1%, and 4.5% when patients were treated with optimal therapy. Retinal events had a lower risk of long-term recurrent ipsilateral stroke (hazard ratio=0.228, CI=0.082 to 0.632,
P
=0.004) than cerebral events. A recurrent or residual stenosis of >50% had a statistically significant effect on long-term stroke recurrence in multivariate analysis (hazard ratio=2.187, CI=1.173 to 4.078,
P
=0.014).
Conclusions—
Patients with retinal presentations are a lower risk group to treat. Residual stenosis or restenosis >50% has a statistically significant trend to an increased risk of recurrence for ipsilateral stroke in the long term in this population. In our patients, a combination of procedural modifications and pharmacological changes seems to improve outcomes.
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Affiliation(s)
- Marc S. Randall
- From the Neurology Department (M.S.R., F.M.M., S.K., K.E., G.S.V.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Royal Hallamshire Hospital; and Sheffield Vascular Institute (T.J.C., P.A.G.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Fiona M. McKevitt
- From the Neurology Department (M.S.R., F.M.M., S.K., K.E., G.S.V.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Royal Hallamshire Hospital; and Sheffield Vascular Institute (T.J.C., P.A.G.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Sanjeev Kumar
- From the Neurology Department (M.S.R., F.M.M., S.K., K.E., G.S.V.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Royal Hallamshire Hospital; and Sheffield Vascular Institute (T.J.C., P.A.G.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Trevor J. Cleveland
- From the Neurology Department (M.S.R., F.M.M., S.K., K.E., G.S.V.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Royal Hallamshire Hospital; and Sheffield Vascular Institute (T.J.C., P.A.G.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Keith Endean
- From the Neurology Department (M.S.R., F.M.M., S.K., K.E., G.S.V.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Royal Hallamshire Hospital; and Sheffield Vascular Institute (T.J.C., P.A.G.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Graham S. Venables
- From the Neurology Department (M.S.R., F.M.M., S.K., K.E., G.S.V.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Royal Hallamshire Hospital; and Sheffield Vascular Institute (T.J.C., P.A.G.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Peter A. Gaines
- From the Neurology Department (M.S.R., F.M.M., S.K., K.E., G.S.V.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Royal Hallamshire Hospital; and Sheffield Vascular Institute (T.J.C., P.A.G.), Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, UK
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