Reduction of postoperative care unit observation time following carotid endarterectomy: a targeted approach

Abstract

To evaluate the safety and feasibility of reducing the postoperative care unit (POCU) observation period from four hours to two hours following carotid endarterectomy (CEA) for asymptomatic, high grade carotid stenosis. Monocentric, retrospective-prospective observational cohort study. The study evaluated the impact of reducing the routine POCU observation period following CEA on patient safety and early postoperative outcomes. No changes in surgical technique and anesthetic management were implemented during the study period. Beginning in March 2024, a revised postoperative monitoring protocol was implemented at our institution, reducing the standard postoperative observation time from four to two hours. For the patient cohort one year prior, between January 2023 and February 2024, a retrospective analysis was conducted. For the patients undergoing surgery from March 2024 onward, a standardized postoperative protocol was implemented in order to evaluate the new clinic standards. During the study period, 382 patients underwent CEA. Of these, 209 patients (54.7%) were excluded, predominantly due to symptomatic carotid stenosis. Overall, 173 patients (45.3%) met the inclusion criteria and were included in the analysis, with 87 assigned to Group I (4-hour monitoring) and 86 to Group II (2-hour monitoring).The overall incidence of postoperative complications during POCU stay did not differ significantly between the two groups (23% vs. 25.6%, p = .76). The majority of events occurred within the first 100 minutes after surgery. Postoperative bleeding requiring readmission to the POCU and surgical revision occurred in two cases (2.3%) in Group I and in one case (1.2%) in Group II (p = 1). Transient neurologic deficits were observed in two patients (2.3%) in Group I and in one patient (1.2%) in Group II (p = 1). In all cases, neurologic symptoms resolved spontaneously during hospital stay. Shortening the POCU observation period after CEA in asymptomatic patients appears safe and is not associated with an increased risk of complications.