Carotid endarterectomy in the elderly population: A statewide experience

Abstract

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.

Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures

“…Two studies did not conduct a risk adjustment, and no study used clinical data for this purpose. 36,47 Hospital volume was the sole unit of analysis in 6 studies, 21,21,32,34,38,43 the surgeon alone in 4 studies, 36,42,46,47 surgeon speciality and case load in 5 studies, 39,40,45,50,52 the institute and surgeon volume in 8 studies, † and hospital, surgeon volume, and discipline in 2 reports. 10,48 Hospital mortality and nonfatal stroke were the primary outcomes measured in included studies.…”

“…Five groups also appraised morbidity (cardiac and minor complications) and length of stay. 37,38,48,49,51 Four studies did not perform a risk adjustment analysis, 36,37,45,47 and data from a clinical, as distinct from an administrative database, was used for this function in only six articles. 36,[39][40][41][42][43][44][45] One study assessed clinical processes of care, 50 and no study assessed appropriateness of patient selection.…”

Multistate utilization, processes, and outcomes of carotid endarterectomy

“…The number of procedures in our study is more than five times larger than any previously reported communitywide, medical record review of CEA procedures (individual reports summarized in Appendix V). [10][11][12][13][14][15][16][17][18][19][20][21] Medical record review is necessary to determine the indication for the procedure, to determine care processes associated with the procedure, and to accurately capture complications. The Medicare databases also allowed us to identify hospital readmissions (regardless of whether the readmission occurred at the same hospital as the procedure) and outof-hospital deaths.…”

Morbidity and Mortality in Vascular Surgery: The Kentucky Experience with a Statewide Database

“…The details of the CEA experience have been previously published. 4 There were 738 CEAs done on 705 patients by 98 surgeons in 41 hospitals. There were 348 right CEAs, 390 on the left, and 33 staged bilateral procedures.…”