Effects of a carotid endarterectomy critical pathway on intensive care unit (ICU) utilization

Introduction: The postoperative care of carotid endarterectomy (CEA) patients has been revolutionized by the implementation of critical pathways with the goal of decreasing CEA costs by reducing length of stay while maintaining quality of patient care. However, the effects of the pathway in the ICU have not been reviewed. The purpose of this study is to evaluate the effects of the CEA pathway on ICU length of stay, hospital length of stay, and utilization of vasoactive agents. Methods: The CEA critical pathway was implemented at our institution in fiscal year 1997. Patients undergoing CEA during 1996 (PreCP) were compared to those undergoing the procedure in 1998 (PostCP). Patient demographics, length of hospital stay, length of ICU stay, and intravenous vasoactive agent utilization were reviewed. Results: Average age was 67.3 +/- 9.6 years in the PreCP versus 66.4 +/- 7.8 years in the PostCP group. Male to female ratio was 1.6 in both groups. Mean hospital length of stay was 6.7 +/- 4.5 days PreCP and 1.9 +/- 1.0 days PostCP (p<0.05), and ICU length of stay was 39.4 +/- 40 hours PreCP versus 24.5 +/- 7.0 hours PostCP. 81% of PreCP patients were on an average of 2 continuous infusion of vasoactive agents, while 91% of PostCP patients were on an average of 1.4 vasoactive agents. There was no difference in the number of complications between the groups. Conclusions: The CEA critical pathway resulted in decreased ICU length of stay and resource utilization as well as decreased hospital length of stay.