Alexandru Barb, Armend Salihi, Johannes Hatzl, Moritz Sebastian Bischoff, Sarah Dehne, Markus Alexander Weigand, Dittmar Böckler
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引用次数: 0
Abstract
Purpose: 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.
Methods: 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.
Results: 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.
Conclusion: Shortening the POCU observation period after CEA in asymptomatic patients appears safe and is not associated with an increased risk of complications.
目的：评价将颈动脉内膜切除术（CEA）后4小时的术后护理病房（POCU）观察时间缩短至2小时治疗无症状、高度颈动脉狭窄的安全性和可行性。设计：单中心、回顾性-前瞻性观察队列研究。方法：研究评估CEA术后减少常规POCU观察时间对患者安全和术后早期结局的影响。在研究期间，手术技术和麻醉管理没有改变。从2024年3月开始，我院实施了修订后的术后监测方案，将标准的术后观察时间从4小时减少到2小时。对一年前（2023年1月至2024年2月）的患者队列进行回顾性分析。对于2024年3月以后接受手术的患者，实施了标准化的术后方案，以评估新的临床标准。结果：研究期间，382例患者行CEA。其中，209例（54.7%）患者被排除，主要是由于症状性颈动脉狭窄。总体而言，173例患者（45.3%）符合纳入标准并纳入分析，其中87例分配到I组（4小时监测），86例分配到II组（2小时监测）。两组在POCU住院期间的术后并发症总发生率无显著差异（23% vs. 25.6%, p = 0.76）。大多数事件发生在手术后的前100分钟。I组2例（2.3%）和II组1例（1.2%）发生术后出血，需要再次进入POCU并进行手术翻修（p = 1）。I组有2例（2.3%）患者出现短暂性神经功能缺损，II组有1例（1.2%）患者出现短暂性神经功能缺损（p = 1）。所有病例的神经系统症状均在住院期间自行消退。结论：缩短无症状患者CEA后POCU观察期是安全的，且与并发症风险增加无关。
期刊介绍：
Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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