Changes In Care Lower Costs Of Surgery To Prevent Stroke

October 08, 1998

DALLAS, October 9 -- Life-saving surgery to prevent stroke is cheaper and takes less time for recovery as a result of changes that have streamlined stroke management, according to a study in this month's Stroke: Journal of the American Heart Association.

The surgery, called carotid endarterectomy, clears fatty plaque buildup from the blood vessels to the brain. These obstructions can block blood flow to the brain, causing a stroke.

"Our data clearly indicate that carotid endarterectomy is becoming less costly without becoming inefficient or compromising the quality of patient care, as is proven by the decrease in complications associated with strokes in the study," says Liliana Smurawska, M.D., of the stroke research unit at the Sunnybrook Health Science Center, University of Toronto, Canada.

If carotid endarterectomy is performed before a person has symptoms of a stroke or blocked blood vessels, generally fewer complications occur and the hospital stay is shorter, resulting in lower costs, says Smurawska. More than half the costs of any procedure are for the operating room and intensive care after surgery. "Post-operative intensive care is often not necessary," she says. Physicians and surgeons in Canada, reacting to pressure from hospital managers to cut costs, are screening more carefully to diagnose and monitor people with strokes and have limited the time patients are in the hospital before and after surgery. Careful screening has led to an increase in the number of patients having the procedure before symptoms or a stroke occur.

Patients admitted for the surgery at the end of the study period paid about $3,000 (Canadian) less for their care than patients admitted at the beginning of the study.

"The lower costs and shorter hospital stays are mainly due to careful preoperative evaluation and, consequently, fewer complications. Doctors are also getting better at determining who are the best candidates for carotid endarterectomy," she says.

Researchers evaluated 757 patients at hospitals around Toronto who had undergone carotid endarterectomy. By the end of the study, the length of time from hospital admittance to surgery decreased from about two days to one day, and the time from surgery to discharge shortened from about five days to three days. Co-authors are B. Bowyer, R.N.; D. Dowed, M.D.; R. Maggisano, M.D.; P. Oh, M.D.; and J.W. Norris, M.D.
Media advisory: Dr. Smurawska can be reached by phone at (416) 480-4287; or by fax at (416) 480-5753. (Please do not publish numbers.)

American Heart Association

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