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Reduction in hospitalisation rates following simultaneous carotid endarterectomy and coronary artery bypass grafting; experience from a single centre

Narcis Hudorovi^*

Department of Vascular Surgery, University Hospital ‘Sestre Milosrdnice’, 10000 Zagreb, Vinogradska 29, Croatia

*Corresponding author. Tel.: +385-1-4640774, fax: +385-1-4640656.

E-mail address: narcis.hudorovic{at}zg.htnet.hr (N. Hudorovi).

The aim of this study was to compare hospital, clinical, and health care cost among patients undergoing reversed staged procedure coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG) first and carotid endarterectomy (CEA) second (control group), compared with patients who had simultaneous CEA and off-pump CABG (study group). From January 1, 2000 to December 31, 2004, 53 consecutive patients underwent combined operations at a single institution. Reversed staged procedures were used in the first 23 patients (January 2000–September 2003), and the next 30 patients (September 2003–September 2004) received the one-stage operations. The two groups were similar with respect to baseline characteristics. An internal control system was implemented at the University Clinic Cardiovascular Department (UCCD) in order to compare staged versus simultaneous CEA/OPCABG. The objectives of the internal control system were two-fold: (1) to collect clinical outcomes, resource utilization on patients undergoing reverse-staged or simultaneous OPCABG/CEA and (2) to compare reverse-staged OPCABG/CEA patients, to patients receiving simultaneous CEA/OPCABG in a UCCD. Study patients spent statistically significantly less time in the hospital than control patients (10 vs. 17.9 days). The difference in the mean annual cost of simultaneous versus staged surgery was estimated to be –11.417 Euros (9.619 vs. 21.028 Euros).

Key Words: Coronary artery disease; Carotid occlusive disease; Coronary revascularization; Vascular reconstruction; Hospitalizations; Cost-effectiveness