The results of elective treatment of abdominal aortic aneurysms are excellent in many institutions. To our knowledge, however, no study has compared the results in a large geographic area in which patients were treated by a variety of surgeons and hospitals. We studied the results of repairing abdominal aortic aneurysms for all Medicare recipients during a single year in Kentucky. One hundred thirty-six operations were performed by 52 surgeons in 31 hospitals. Overall operative mortality was 18%; elective and emergency operative mortality rates were 6% and 49%, respectively. Advancing age did not affect outcome, but mortality due to ruptured aneurysms was higher in smaller hospitals than in larger hospitals. The low mortality for elective repair of abdominal aortic aneurysms in an elderly population by numerous surgeons in divergent hospitals is a strong indication for its liberal use compared with the high mortality and morbidity of emergency surgery.
The practice of carotid endarterectomy (CEA) was examined in all Medicare patients undergoing operation in the state of Kentucky during 1983 and during the first 6 months of 1984. CEA was performed 738 times on 705 patients in 1983 by 98 surgeons in 41 hospitals. The average age of patients was 71 years, and only 15% had no symptoms of carotid disease. The stroke rate was 3.7%, and the combined stroke and mortality rate was 5.7%. In a follow-up period in 1984, the combined stroke and mortality rate was 4.3%. Patients who showed no symptoms of carotid disease had a combined stroke and mortality rate of 2.8%. Surgeons performing fewer than three CEAs per year had a tendency toward a higher complication rate than had surgeons performing more than 12 CEAs a year. Most stroke complications appeared as isolated events and did not seem to represent a practice pattern based on our follow-up into 1984.
The practice of carotid endarterectomy (CEA) was examined in all Medicare patients undergoing operation in the state of Kentucky during 1983 and during the first 6 months of 1984. CEA was performed 738 times on 705 patients in 1983 by 98 surgeons in 41 hospitals. The average age of patients was 71 years, and only 15% had no symptoms of carotid disease. The stroke rate was 3.7%, and the combined stroke and mortality rate was 5.7%. In a follow-up period in 1984, the combined stroke and mortality rate was 4.3%. Patients who showed no symptoms of carotid disease had a combined stroke and mortality rate of 2.8%. Surgeons performing fewer than three CEAs per year had a tendency toward a higher complication rate than had surgeons performing more than I2 CEAs a year. Most stroke complications appeared as isolated events and did not seem to represent a practice pattern based on our follow-up into 1984.
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