Do Vascular Surgeons Improve the Outcome of Carotid Endarterectomy? An Analysis of 12,618 Elective Cases in the State of Connecticut
| Autor: | Randolph E. Edwards, Alan Dardik, Desarom Teso, Stanley J. Dudrick, Jimmy N. Antezana |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Heart Diseases Heart disease medicine.medical_treatment Carotid endarterectomy Postoperative Hemorrhage Logistic regression Postoperative stroke medicine Humans Radiology Nuclear Medicine and imaging In patient Stroke Aged Endarterectomy Aged 80 and over Endarterectomy Carotid business.industry Age Factors General Medicine Length of Stay Middle Aged medicine.disease Surgery Treatment Outcome Postoperative mortality Epidemiologic Methods Cardiology and Cardiovascular Medicine business |
| Zdroj: | Vascular. 12:155-165 |
| ISSN: | 1708-539X 1708-5381 |
| DOI: | 10.1258/rsmvasc.12.3.155 |
| Popis: | Because cardiac complications may predict long-term survival after carotid endarterectomy (CEA), this study evaluates contemporary outcome, including cardiac complications, after CEA. Patients in Connecticut hospitals undergoing CEA between 1991 and 2002 were identified using the state discharge database (Chime, Inc.; < www.cthosp.org >). Of the 12,618 CEAs performed, there were 53 (0.4%) deaths, 155 (1.2%) neurologic complications, and 300 (2.4%) cardiac complications. Despite an increase in patient age ( p < .0001, Kruskal-Wallis test) over time, there were decreases in mortality ( p = .0001, chi-square), postoperative stroke ( p = .001), and cardiac complications ( p = .0003). Vascular surgeons performed a minority of the procedures in the state (11%), but there were fewer cardiac complications after CEA performed by vascular surgeons than general surgeons (0.8% vs 3.0%; p < .0001). Multivariable logistic regression demonstrated that the risk of a cardiac complication was elevated in patients operated on by a nonvascular surgeon, patients with previous heart disease or stroke, and the elderly. In a state with very high performance of CEA by general and nonvascular surgeons, postoperative mortality and neurologic complications remain low. However, there were fewer cardiac complications when a vascular surgeon performed the procedure. These results suggest that increased referral to vascular surgeons could improve procedural safety. |
| Databáze: | OpenAIRE |
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