Role of interactive home telemedicine for early and protected discharge 1 day after carotid endarterectomy

Abstract

Our aim was to prove the feasibility and safety of a protocol for early and protected discharge 1 day after carotid endarterectomy (CEA) using a system of telemedicine (TMD) monitoring. Among 147 patients operated upon for 163 CEAs, we selected a group (A) of 36 patients fulfilling criteria for discharge 1 day after surgery. An electronic blood pressure manometer, a videophone, an antihypertensive drug (amlodipine), and a customer satisfaction questionnaire were given to every group A patient. With a video-communication program linked to the Web, we monitored every 4 hours (from 8:00 a.m. to 8:00 p.m.) for 2 days the surgical wound, blood pressure, and heart frequency of the patients. Other patients were included in group B. No differences regarding demographic characteristics, risk factors, carotid lesions, operative time, postoperative complications, or blood loss were noted between group A and group B. Twenty-one patients in group A were actually discharged 1 day after surgery. No cervical hematoma developed. Three hypertensive crises were treated successfully in group A. From the questionnaire a feeling of insecurity at discharge emerged, but it rapidly resolved. The overall cost of video connections was 25.39 +/- 0.25 Euros per patient. CEA can be safely done as 1-day surgery using a TMD monitoring system in selected cases. Our protocol allowed early discharge safely, leading to reduced hospital costs.