A Population-Based Study of Risk Factors for Stroke After Carotid Endarterectomy Using the ACS NSQIP Database

Gupta, Prateek K.; Pipinos, Iraklis I.; Miller, Weldon J.; Gupta, Himani; Shetty, Shreya; Johanning, Jason M.; Longo, G. Matthew; Lynch, Thomas G.

doi:10.1016/j.jss.2010.10.010

Cited by 31 publications

(27 citation statements)

References 48 publications

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“…[25][26][27] Like Arozullah et al, 7 this study also found dependent functional status to be a risk factor associated with PRF. Higher ASA class, Physicians have long quoted the most current literature to explain risks of adverse outcomes associated with a procedure.…”

Section: Development and Validation Of Risk Modelsupporting

confidence: 70%

Development and Validation of a Risk Calculator Predicting Postoperative Respiratory Failure

Gupta

Fang

et al. 2011

Chest

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205

131

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Section: Development and Validation Of Risk Modelsupporting

confidence: 70%

Development and Validation of a Risk Calculator Predicting Postoperative Respiratory Failure

Gupta

Fang

et al. 2011

Chest

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205

131

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“…15-17 These patients have been excluded from most trials due to their higher perioperative risk and relatively shorter life expectancy. 18 ACAS and the Asymptomatic Carotid Surgery Trial showed an absolute stroke risk reduction of approximately 5% over 5 years, 1,19 which necessitates a long enough life expectancy for the benefits to be realized.…”

Section: Discussionmentioning

confidence: 99%

Risk index for predicting perioperative stroke, myocardial infarction, or death risk in asymptomatic patients undergoing carotid endarterectomy

Gupta

Ramanan

MacTaggart

et al. 2013

Journal of Vascular Surgery

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Objective The latest guidelines recommend performance of carotid endarterectomy (CEA) on asymptomatic patients with high-grade carotid stenosis, only if the combined perioperative stroke, myocardial infarction (MI), or death risk is ≤3%. Our objective was to develop and validate a risk index to estimate the combined risk of perioperative stroke, MI, or death in asymptomatic patients undergoing elective CEA. Methods Asymptomatic patients who underwent an elective CEA (n = 17,692) were identified from the 2005-2010 National Surgical Quality Improvement Program, a multicenter, prospective database. Multivariable logistic regression analysis was performed with primary outcome of interest being the composite of any stroke, MI, or death during the 30-day periprocedural period. Bootstrapping was used for internal validation. A risk index was created by assigning weighted points to each predictor using the β-coefficients from the regression analysis. Results Fifty-eight percent of the patients were men with a median age of 72 years. Thirty-day incidences of stroke, MI, and death were 0.9% (n = 167), 0.6% (n = 108), and 0.4% (n = 72), respectively. The combined 30-day stroke, MI, or death incidence was 1.8% (n = 324). On multivariable analysis, six independent predictors were identified and a risk index created by assigning weighted points to each predictor using the β-coefficients from the regression analysis. The predictors included age in years (<60: 0 point; 60-69: −1 point; 70-79: −1 point; ≥80: 2 points), dyspnea (2 points), chronic obstructive pulmonary disease (3 points), previous peripheral revascularization or amputation (3 points), recent angina within 1 month (4 points), and dependent functional status (5 points). Patients were classified as low (<3%), intermediate (3%-6%), or high (>6%) risk for combined 30-day stroke, MI, or death, based on a total point score of <4, 4-7, and >7, respectively. There were 15,249 patients (86.2%) in the low-risk category, 2233 (12.6%) in the intermediate-risk category, and 210 (1.2%) in the high-risk category. Conclusions The validated risk index can help identify asymptomatic patients who are at greatest risk for 30-day stroke, MI, and death after CEA, thereby aiding patient selection.

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“…Similar associations were also demonstrated in two recent ACS NSQIP analyses focusing on the identification of preoperative risk factors for postoperative complications. 8,34 The risk factors identified in these studies were not identical to those determined in this analysis and also differed among each other. This may be explained by the smaller dataset used in these studies, different primary outcomes, and/or by variations in the statistical models.…”

Section: Discussionmentioning

confidence: 56%

Outcomes of carotid endarterectomy under general and regional anesthesia from the American College of Surgeons' National Surgical Quality Improvement Program

Leichtle

Mouawad

Welch

et al. 2012

Journal of Vascular Surgery

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A Population-Based Study of Risk Factors for Stroke After Carotid Endarterectomy Using the ACS NSQIP Database

Cited by 31 publications

References 48 publications

Development and Validation of a Risk Calculator Predicting Postoperative Respiratory Failure

Development and Validation of a Risk Calculator Predicting Postoperative Respiratory Failure

Risk index for predicting perioperative stroke, myocardial infarction, or death risk in asymptomatic patients undergoing carotid endarterectomy

Outcomes of carotid endarterectomy under general and regional anesthesia from the American College of Surgeons' National Surgical Quality Improvement Program

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