Abstract WP364: Local Guideline And Protocol For Carotid Revascularization

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Abstract

Introduction: Stroke is the leading cause of disability in Brazil. It is estimated that carotid atherosclerotic disease accounts for 10% to 20% of all strokes. Carotid revascularization procedures, to be considered beneficial, should be performed in centers with low complication rates and in carefully selected patients.

Objective: To compare the rates of neurological complications (stroke or transient ischemic attack (TIA) before and after implementation of a hospital protocol based on the best scientific evidence with the multidisciplinary participation of all professionals involved in the care of these patients and to compare costs of the procedures after implementation of this protocol.

Method: A hospital guideline and protocol based on the best scientific evidence were developed and implemented in May 2015. We compared the complication rates pre and post implementation of the guideline (2009 to 2012), as well as the costs associated with procedures in both periods.

Results: Pre-protocol analysis: of the 38 patients undergoing endarterectomy, 73% (n = 28) were males and the mean age was 74 years. A total of 8% (n = 3) presented stroke or TIA in the postoperative period. Of the 31 patients undergoing carotid angioplasty, 77% (n = 24) were males and the mean age was 75 years. A total of 16% (n = 5) presented stroke or TIA in the postoperative period. Post-protocol period analysis: Of the 48 patients who underwent a carotid revascularization procedure, 27 underwent endarterectomy and 21 underwent carotid angioplasty. The mean age was 73 years for both groups. There were no post-procedure neurological complications after the implementation of the protocol, either after carotid endarterectomy or carotid angioplasty . There was a decrease in the average ticket of endarterectomies (from $ 20213 to $ 18.010, p=0.4) and of angioplasties (from $ 36935 to $ 25.327, p=0.06), a reduction of the mean cost of endarterectomies of 11% and 31 % for angioplasties.

Conclusion: In conclusion, the implementation of a carotid disease protocol in a tertiary Brazilian hospital has guaranteed patient safety with improvement of the immediate postoperative outcomes, in addition to the reduction of costs related to the procedures.

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