1. Comparing Post-operative Pain and Other Outcomes in Carotid Endarterectomy Versus Transcarotid Artery Revascularization.
- Author
-
Dorey, Trevor, Parmiter, Sara, Sanders, Jamie, Turcotte, Justin, and Jeyabalan, Geetha
- Subjects
- *
CAROTID artery surgery , *PAIN measurement , *MORPHINE , *POSTOPERATIVE pain , *PATIENT readmissions , *REVASCULARIZATION (Surgery) , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *HOSPITAL emergency services , *RECOVERY rooms , *INTRAOPERATIVE care , *OPIOID analgesics , *POSTOPERATIVE period , *LENGTH of stay in hospitals , *CAROTID endarterectomy - Abstract
Background: Transcarotid artery revascularization (TCAR) is growing in popularity. Although major clinical end-points such as stroke rate and mortality are well-known, patient reported outcomes such as pain, and length of stay are among the purported benefits that are as yet untested. We sought to determine if there are differences in pain and other clinical outcomes when comparing carotid endarterectomy (CEA) and TCAR. Methods: We performed a retrospective review of 326 patients undergoing TCAR (n = 50) or CEA (n = 276) from 2019-2023. Primary outcomes of interest were maximum pain numeric rating scales (NRS) reported in the post-anesthesia care unit (PACU) and on postoperative days (POD) zero and 1, and oral morphine milligram equivalents (OMMEs) received intraoperatively through POD1. Secondary outcomes included length of stay (LOS), complications, and 30-day emergency department (ED) returns/readmissions. Results: Fifty TCAR and 150 CEA patients were included in the propensity score matched cohorts. TCAR patients reported lower pain-NRS in PACU (P <.001) and on POD0 (P =.002), but similar pain scores on POD1 (P =.112). Postoperatively, TCAR patients were less likely to receive opioids (52% vs 75.3%, P =.003) and received less OMME from PACU through POD1 (12.8 ± 16.2 vs 23.2 ± 27.2, P =.001). After adjusting for age, sex, BMI, prior chronic opioid use, and prior carotid surgery, TCAR patients were approximately 70% less likely to receive post-operative opioids. No significant differences in LOS, 30-day ED returns/readmissions, or complications were observed between groups. Conclusions: Compared with CEA, patients undergoing TCAR reported lower pain scores and consumed fewer narcotics overall. However, the absolute difference was modest, and pain scores were low in both cohorts. Differences in pain and post-operative narcotic use may be of less importance when deciding between TCAR and CEA. Total non-opioid protocols may be feasible in both approaches. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF