Risk modelling study for carotid endarterectomy

Abstract

Diabetes, heart disease and stroke are significant risk factors for stroke or death following CEA. The risk score model identified patients at higher risk and aided in comparative audit.

Systematic Review of Carotid Artery Procedures and the Volume-Outcome Relationship in Europe

“…OR range 0.99-1.50 with high volume quintile as reference suggesting a relationship between volume and in-hospital mortality; there was a statistically significant relationship between the two lowest quantiles and highest volume groupings Quantile 1 vs quantile 5 -OR 1.50 (95%CI 1.20-1.86 p<0.001) Quantile 2 vs quantile 5 -OR 1.18 (95%CI 1.02-1.38 p<0.031) In hospital stroke (any) or death adjusted regression modelling with volume as a continuous variable hospital volume as a continuous variable plotted against outcome suggests evidence of a statistically significant effect Kuhan 15,16 (n=741) 30 day stroke or death rate using regression modelling adjusted for age, sex, and comorbidities, contralateral internal carotid artery occlusion, side of operation, shunt, patch, ASA grade, surgeon, and vascular unit.…”

“…Insert Table II Three studies (n=3752) 12,13,15,16 conducted analyses using data from national vascular registries using a variety of statistical techniques and levels of adjustment and found no statistically significant evidence of a relationship, these studies were smaller and older.…”

“…Five studies reported the relationship using UK data sources 11,15,16,18,19,21 Nine studies [11][12][13][14][15][16][17][20][21][22] analysis of data collected as part of an administrative database.…”

“…Kuhan (2001) finds no significant differences between surgeons 'Focussing now on this distribution, there was little variability in outcome after adjustment for significant risk factors between the four surgeons studied'…”

“…This relationship was maintained when patient related factors and hospital volume were also adjusted for 12 , though his effect was not evident when adjustment for total vascular caseload was included in the analysis. Kuhan 15,16 conducted analyses using regression modelling which included only four surgeons and found no evidence of a statistically significant relationship. 19 found no evidence of a relationship between individual surgeon's volume and 30-day stroke in CEA patients, though scant details of the analysis were provided.…”