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Invited Commentary

Michael Appleberg, MD
Arch Surg. 1996;131(7):755. doi:10.1001/archsurg.1996.01430190077019.
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In the current medicoeconomic environment, clinicians worldwide need to identify those areas where costs may be rationalized and contained, while at the same time ensuring that clinical services are provided at the same high level of quality that has always been expected.

The authors of this study have reviewed carotid endarterectomy as an operative procedure to which contemporary practice guidelines of same-day admission and early discharge can be applied. They have demonstrated that high-quality service can be provided, with same-day admission achieved in 76% of patients in this series and with 80% of patients discharged by day 2 postoperatively. This fast-track protocol resulted in a mean length of stay of 3.8 days, compared with the diagnosis related group mean length of stay of 5.6 days. This study has also demonstrated that ICUs should be very selectively employed postoperatively. The majority of patients can be treated appropriately in specialized ward areas

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