Routine intensive-care unit admission post-carotid endarterectomy (CEA) has been the standard of care in various institutions. In recent years the cost-effectiveness of this practice has come under question. the aim of this analysis was to study the need for intensive-care admission in the post-operative period of patients undergoing CEA, and to identify risk factors predictive of need for prolonged intensive-care intervention (> 12 hours).
Retrospective analysis of clinical data from patients undergoing CEA at Cooper University Hospital during the time period of 1999-2004.Intensive-care interventions included: administration of vasoactive drugs, intravenous fluids for low blood pressure, myocardial ischemia, arrhythmia that required intravenous medication, congestive heart failure, need for re-operation for stroke or hematoma, administration of aggressive bronchodilator therapy, high-flow oxygen, and endotracheal intubation.
A total of 219 patients who underwent isolated CEA were studied. Mean age was 69.5 (±9.4) years, 61% of patients were male, and co morbidities included: hypertension 87%, cardiac disease 61%, and diabetes 31%. Of the total group 57.1% required some form of intensive-care intervention; and only 22.8% required an intensive-care intervention more than 12 hours after surgery. The most common intervention was the administration of vasoactive drugs for elevated blood pressure (81.6%). Preoperatively the presence of hypertension and diabetes were associated with the need for intensive-care intervention > 12 hours. Intraoperative characteristics such as type of anesthesia and length of surgery were not associated with increased need for intensive-care intervention > 12 hours. However, intraopretative administration of continuous vasoactive drugs was strongly associated with the need for intensive-care intervention > 12 hours (p = 0.0001).
Patients undergoing CEA frequently receive intensive-care interventions in the early post-operative period (<12 hours). Intraoperative use of vasoactive drugs is a strong predictor of need for prolonged intensive-care intervention (> 12 hours).
Patients undergoing CEA require short term monitoring in an intensive-care setting.the intraoperative use of vasoactive drugs predict the need for a prolonged intensive-care intervention.
Rim Atoui, None.