Document Detail


Carotid artery stenting has increased rates of postprocedure stroke, death, and resource utilization than does carotid endarterectomy in the United States, 2005.
MedLine Citation:
PMID:  18829236     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Carotid endarterectomy (CEA) remains the procedure of choice for treatment of patients with severe carotid artery stenosis. The role of carotid artery stenting (CAS) in this patient group is still being defined. Prior single and multicenter studies have demonstrated economic savings associated with CEA compared with CAS. The purpose of this study was to compare surgical outcomes and resource utilization associated with these two procedures at the national level in 2005, the first year in which a specific ICD-9 procedure code for CAS was available.
METHODS: All patient discharges for carotid revascularization for the year 2005 were identified in the Nationwide Inpatient Sample based on ICD9-CM procedure codes for CEA (38.12) and CAS (00.63). The primary outcome measures of interest were in-hospital mortality and postoperative stroke; secondary outcome measures included total hospital charges and length of stay (LOS). All statistical analyses were performed using SAS version 9.1 (Cary, NC), and data are weighted according to the Nationwide Inpatient Sample (NIS) design to draw national estimates. Univariate analyses of categorical variables were performed using Rao-Scott chi(2), and continuous variables were analyzed by survey weighted analysis of variance (ANOVA). Multivariate logistic regression was performed to evaluate independent predictors of postoperative stroke and mortality.
RESULTS: During 2005, an estimated 135,701 patients underwent either CEA or CAS nationally. Overall, 91% of patients underwent CEA. The mean age overall was 71 years. Postoperative stroke rates were increased for CAS compared with CEA (1.8% vs 1.1%, P < .05), odds ratio (OR) 1.7; (95% confidence interval [CI] 1.2-2.3). Overall, mortality rates were higher for CAS compared with CEA (1.1% vs 0.57%, P < .05) this difference was substantially increased in regard to patients with symptomatic disease (4.6% vs 1.4%, P < .05). By logistic regression, CAS trended toward increased mortality, OR 1.5; (95% CI .96-2.5). Overall, the median total hospital charges for patients that underwent CAS were significantly greater than those that underwent CEA ($30,396 vs $17,658 P < .05).
CONCLUSIONS: Based on a large representative sample during the year 2005, CEA was performed with significantly lower in-hospital mortality, postoperative stroke rates, and lower median total hospital charges than CAS in US hospitals. As the role for CAS becomes defined for the management of patients with carotid artery stenosis, clinical as well as economic outcomes must be continually evaluated.
Authors:
James T McPhee; Andres Schanzer; Louis M Messina; Mohammad H Eslami
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2008-10-01
Journal Detail:
Title:  Journal of vascular surgery     Volume:  48     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2009-01-02     Completed Date:  2009-01-22     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1442-50, 1450.e1     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Vessel Prosthesis / adverse effects*
Carotid Stenosis / surgery*
Cause of Death / trends
Confidence Intervals
Endarterectomy, Carotid / adverse effects*,  utilization*
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Odds Ratio
Postoperative Complications
Prognosis
Retrospective Studies
Risk Factors
Stents / adverse effects*
Stroke / epidemiology*,  etiology
Survival Rate / trends
United States / epidemiology
Young Adult
Comments/Corrections
Comment In:
J Vasc Surg. 2009 Jul;50(1):238-9; author reply 239   [PMID:  19563982 ]

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