The effect of the day of week on outcomes after carotid endarterectomy for asymptomatic carotid stenosis
Thomas E. Cheng, M.S., Alik Farber, M.D., Jeffrey A. Kalish, M.D., Myriam Castagne, Denis Rybin, Ph.D., Gheorghe Doros, Ph.D., Sevan Komshian, MS, Jeffrey J. Siracuse, M.D..
Boston University, Boston, MA, USA.
OBJECTIVES: Length of stay (LOS) is commonly used to gauge hospital resource utilization. General surgery operations, such as colectomy and cholecystectomy, performed earlier in the week have been previously shown to have a shorter LOS and lower patient morbidity. Our goal was to investigate whether asymptomatic patients undergoing elective carotid endarterectomy (CEA) earlier in the week had a shorter LOS and improved clinical outcomes.
METHODS: The Vascular Quality Initiative (VQI) database was queried for asymptomatic CEA performed on weekdays from 2005 to 2016. Univariate and multivariate analysis was completed to compare outcomes based on the day of the week.
RESULTS: There were 25,655 asymptomatic CEAs performed on Monday (5210 (20.3%)), Tuesday (5879 (22.9%)), Wednesday (5491 (21.4%)), Thursday (4856 (18.9%)), and Friday (4219 (16.4%)). The mean patient age was 70.5 years and 59.1% were male. There were no significant differences in comorbidities based on day of the week. Perioperative complications included 30-day mortality (0.4%), stroke (1.2%), myocardial infarction (MI) (0.7%), and return to the operating room (1.5%). There were no significant differences in perioperative complications including stroke, MI, and 30-day mortality based on the day of the week. The mean LOS was 1.8±2.9 days. Patients were discharged on a statin in 83.8% and aspirin in 91.7% of cases and these did not differ with day of week. CEAs performed on Fridays had a longer LOS (1.9±2.9; P<0.001). Multivariate analysis showed that CEAs performed on Friday were more likely to have a longer LOS compared to those performed on Monday through Thursday (OR: 1.078, 95% CI: 1.053-1.104; P<.001).
CONCLUSIONS: Asymptomatic CEAs performed on Friday were associated with longer LOS, although this did not affect statin and aspirin prescription for discharge. Such LOS increase, albeit small, may affect the hospital bottom line. Early rounding and paperwork preparation on the weekend despite more limited support staff is an area for improvement for discharge time.
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