Improving the appropriateness of carotid endarterectomy: results of three city-wide studies.
Explore the source record for details and available documents.
Canada↗
Biomedical subjects
T B Lubkey
Publications and source records attributed to T B Lubkey.
Improving the appropriateness of carotid endarterectomy: results of a prospective city-wide study.
BACKGROUND AND PURPOSE: In light of previously reported concerns regarding carotid endarterectomy (CEA) use in our city, our goal was to determine the influence of a prospective audit and educational campaign on the performance of CEA with respect to surgical appropriateness and complication frequency. METHODS: Results of our previous audit of 291 CEAs, along with CEA practice guidelines and notification of prospective surveillance, were supplied to surgeons performing CEA in our city. After this, 184 consecutive patients undergoing CEA from September 1996 to August 1997 were followed prospectively. On the basis of blinded standardized remeasurements of angiographic carotid stenoses, CEA was classified as appropriate for patients with symptomatic carotid stenoses >/=70%, uncertain for those with symptomatic stenoses <70% or asymptomatic stenoses >/=60%, and inappropriate for patients with asymptomatic carotid stenoses <60% or preoperative neurological or medical instability. RESULTS: Forty percent of patients were asymptomatic. Compared with our prior audit, the rate of appropriate CEAs improved from 33% previously to 49% of cases in the present study (P=0.0005), uncertain indications did not change significantly (49% versus 47%; P=0.61), and inappropriate indications dropped from 18% to 4% (P=0. 00002). Perioperative stroke or death occurred in 6.4% of symptomatic patients but developed in only 2.7% of asymptomatic patients, which was improved from the 5.1% rate previously found. CONCLUSIONS: In our city, the use of a surgical audit identified areas of concern regarding CEA, and subsequent education and ongoing surveillance significantly improved the use and performance of this procedure.
Carotid Stenosis↗
Dedicated short-stay spinal unit.
Prolonged waiting periods for patients with benign spinal surgical lesions led to the creation of a Dedicated Short Stay Spinal Surgical Unit. This unit was implemented in November, 1992, on a 29 bed Neuroscience Unit in a 1200 bed Acute Care Teaching Hospital. Considerations for implementation were many, including psychological impact of chronic pain for patients on prolonged waiting lists, the increased probability of permanent waiting lists, the increased probability of permanent neurological deficits, and the economic impact to patient, societal and hospital budgets. This paper will focus on explanation of the design of the unit, define the benefits and provide study results of the first 85 patients admitted to the unit.
Adult↗