How Essential Is the Intensive Care Unit After Carotid Endarterectomy?

Abstract

This study was designed to determine whether a short recovery room stay could safely and accurately predict which patients required the Intensive Care Unit (ICU) after carotid endarterectomy (CEA).

After review of the records of all patients who underwent CEA at the author's insti tution between 1988 and 1990, a set of criteria was developed for selecting which patients required the ICU postoperatively. These indications included postoperative neurologic changes, cardiac irritability or ischemia, prolonged need for vasoactive medication, and wound hematomas that might compromise the patient's airway.

Between January 1, 1991 and June 30, 1996, 342 CEAs were performed at the author's institution. Forty-two (12%) patients required the ICU postoperatively; 23 had unstable blood pressure, seven had cardiac problems, 10 had neurologic problems (7 permanent, 3 transient), and three had neck hematomas. One patient originally in the ICU for hypertension was transferred back after developing an intracerebral hemorrhage on postoperative day 2, and one patient was transferred into the ICU for unstable blood pressure that developed on the vascular floor. Preoperative risk factors, indications for operation, and anesthetic technique did not predict which patients would need the ICU. Two patients died within 30 days. There were no readmissions after discharge.

Selection of patients for ICU admission after CEA can be safely and accurately deter mined during a 3-hour stay in the recovery room postoperatively. This selection results in efficient use of ICU resources and tremendous cost savings. By adherence to the protocol, 88% of patients did not need ICU after CEA.