Hospital resource use following carotid endarterectomy in 2006: analysis of the nationwide inpatient sample

Abstract

To explore the relationships among patient age and length of stay (LOS), hospital costs, and discharge disposition following carotid endarterectomy (CEA), we identified discharge records from the 2006 Nationwide Inpatient Sample (NIS). The primary outcome was LOS from the surgical procedure to discharge. We examined LOS from procedure to discharge because the time from procedure to discharge may better reflect hospital stay due to the procedure itself for subjects with symptomatic carotid artery disease compared with the inclusion of days hospitalized for stroke recovery. Secondary endpoints included total LOS, discharge disposition, and cost of hospitalization. More than 90% of the 118,218 discharge records for CEA examined were for patients with asymptomatic carotid disease. The LOS from procedure to discharge and total LOS increased per decade, starting at age 70-79 years. Age per decade increased the likelihood of needed an LOS from procedure to discharge of >1 day. The same trend was seen for the likelihood of needing a >2-day postoperative stay; patients age ≥80 years required the longest postoperative LOS (odds ratio [OR]=1.45 for >1 day and 1.45 for >2 days; both P<.001). Total hospital costs averaged $10,965 for all discharges. For age dichotomized at 80 years, the average cost increased by $845. Age≥80 years also was independently associated with discharge to a skilled nursing facility (SNF) (OR=2.4; 95% confidence interval=2.09-2.76). Hospital LOS and costs following CEA increased with increasing patient age. Morbidity after CEA should be discussed with patients in whom revascularization for asymptomatic disease is being considered.

Figure 1

A) Average length of stay (LOS) from procedure to discharge (days) per decade of life. LOS from procedure is calculated as total LOS minus the number of days between admission and procedure. n=99,421, where this endpoint is non-negative or not missing. B) Average LOS, in total, per decade of life. n=118,218.