Variation in Carotid Endarterectomy Mortality in the Medicare Population: Trial Hospitals, Volume, and Patient Characteristics

Wennberg, David E.; Lucas, F. Lee; Birkmeyer, John D.; Bredenberg, Carl E.

doi:10.1097/00132586-199902000-00020

Cited by 154 publications

(195 citation statements)

References 0 publications

Supporting

Mentioning

181

Contrasting

Unclassified

Order By: Relevance

“…The synergistic effect of high-volume physicians and high-volume centers on better patient outcomes has been described in various studies for coronary artery bypass surgery, 24 percutaneous coronary interventions, 25 and carotid endarterectomy. 26 In a high-volume neurointerventional practice, the risk for neurologic complications related to catheter-based diagnostic cerebral angiography can approach zero. The rate of nonneurologic complications can also be kept at a minimum despite increasingly complex cerebrovascular cases and an increasing population of patients treated with endovascular techniques.…”

Section: Discussionmentioning

confidence: 99%

The Safety of Dedicated-Team Catheter-Based Diagnostic Cerebral Angiography in the Era of Advanced Noninvasive Imaging

Thiex¹,

Norbash²,

Frerichs³

2009

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE:Given the current high quality and usefulness of noninvasive cerebrovascular imaging, invasive angiographic evaluation of the cerebrovascular system is justified if the procedural risk for a neurologic complication is far below the anticipated benefit. The purpose of this study was to evaluate the safety of diagnostic cerebral angiography provided by a dedicated neurointerventional team in a high-volume university hospital.

show abstract

Section: Discussionmentioning

confidence: 99%

The Safety of Dedicated-Team Catheter-Based Diagnostic Cerebral Angiography in the Era of Advanced Noninvasive Imaging

Thiex¹,

Norbash²,

Frerichs³

2009

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…Numerous studies have found that increased hospital or surgeon operative volumes, as measured by the number of procedures performed, are associated with improved patient outcomes following surgery [1][2][3][4]. These findings have been consistent across a wide range of surgical procedures and across different health care systems.…”

Section: Introductionmentioning

confidence: 70%

Using G-Computation to Estimate the Effect of Regionalization of Surgical Services on the Absolute Reduction in the Occurrence of Adverse Patient Outcomes

Austin

Urbach²

2013

Medical Care

View full text Add to dashboard Cite

Background-Numerous studies have found that increased hospital or surgeon operative volumes, as measured by the number of procedures performed, are associated with improved patient outcomes following surgery. These findings have been used to support important health policy decisions about regionalization of surgical services, in which provision of specific surgical services is restricted to hospitals that maintain operative volumes above a specified threshold. The most common statistical approach in volume-outcome studies is to regress patient outcomes on a set of patient characteristics and a variable denoting provider volume. When outcomes are binary, such as operative mortality, logistic regression is used, resulting in the odds ratio being the reported measure of association. However, the odds ratio is a relative measure of effect and does not allow policy-makers to estimate the absolute benefit of regionalization.Objectives-To describe how G-computation can be used to estimate the expected number of lives saved due to regionalization of surgical services.Research Design-Retrospective cohort design of patients undergoing one of three different surgical procedures in Ontario, Canada.Results-Regionalization of colorectal cancer surgery, esophagectomy, or pancreaticoduodenectomy in Ontario could reduce the average annual number of peri-operative deaths by 20.2, 2.0, and 3.6, for the three procedures respectively. Conclusions-The absolute reduction in number of operative deaths due to regionalization of surgical procedures can be calculated. This can help inform health policy debate about benefits of regionalization.

show abstract

“…In another pooled analysis of trials of CEA for symptomatic stenosis in patients aged >75 years, benefit was higher compared to younger patients [21]. Administrative database studies have shown an increased perioperative mortality with increasing age; therefore, careful patient evaluation is mandatory when CEA is contemplated in octogenarians [23]. If an elderly symptomatic CEA candidate is medically fit, CEA should not be withheld.…”

Section: Agementioning

confidence: 99%

“…Previously discussed trials of CEA, such as NASCET and ACAS, excluded patients who were at high risk for perioperative mortality and morbidity, and these patients had substantially worse outcomes than those reported in the trials [23,61]. Patients at "high risk" for CEA have been treated with CAS as part of either industry-supported registries or randomized trials.…”

Section: Cas In "High-risk"patientsmentioning

confidence: 99%

Stroke Prevention-Surgical and Interventional Approaches to Carotid Stenosis

Rajamani

2011

Neurotherapeutics

View full text Add to dashboard Cite

Extracranial carotidartery stenosis is an important cause of stroke that often needs treatment with carotid revascularization. To prevent stroke recurrence, carotid endarterectomy has been well-established for many years in treating symptomatic high-and moderate-grade stenosis. Carotid stenting is an appealing, less invasive alternative to carotid endarterectomy, and several recent trials have compared the efficacy of the 2 procedures in patients with carotid stenosis. Carotid artery stenting has emerged as an important mode of therapy for high-risk patients with symtomatic highgrade stenosis. This review focuses on the current data available that will enable the clinician to decide optimal treatment strategies for patients with carotid stenosis.

show abstract

Variation in Carotid Endarterectomy Mortality in the Medicare Population: Trial Hospitals, Volume, and Patient Characteristics

Cited by 154 publications

References 0 publications

The Safety of Dedicated-Team Catheter-Based Diagnostic Cerebral Angiography in the Era of Advanced Noninvasive Imaging

The Safety of Dedicated-Team Catheter-Based Diagnostic Cerebral Angiography in the Era of Advanced Noninvasive Imaging

Using G-Computation to Estimate the Effect of Regionalization of Surgical Services on the Absolute Reduction in the Occurrence of Adverse Patient Outcomes

Stroke Prevention-Surgical and Interventional Approaches to Carotid Stenosis

Contact Info

Product

Resources

About