Document Detail


Outcomes of carotid endarterectomy: how does the Australian state of New South Wales compare with international benchmarks?
MedLine Citation:
PMID:  12096259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The objective of this study was to determine the outcomes of carotid endarterectomy (CEA) in New South Wales, Australia.
METHODS: This state-wide prospective audit of all public and private hospitals during a 6-month period had main outcome measures of 30-day mortality, 30-day fatal stroke, 30-day nonfatal stroke, and 30-day combined stroke and mortality.
RESULTS: Fifty-three of 54 eligible surgeons participated (response rate, 98%). The audit obtained inpatient data for 689 internal CEA procedures performed on 666 patients. Of 666 first or only procedures, 462 (69.4%) were performed on patients who were symptomatic and 204 (30.6%) on patients who were asymptomatic. After adjustment for cluster by surgeon, we determined a state-wide 30-day death rate of 1.2% (95% CI, 0.3% to 2.1%), a 30-day fatal or nonfatal stroke rate of 3.0% (95% CI, 1.6% to 4.4%; ipsilateral stroke, 2.6%), a 30-day nonfatal stroke rate of 2.3% (95% CI, 1.1% to 3.4%; ipsilateral stroke, 2.0%), and a 30-day combined stroke and death rate of 3.5% (95% CI, 2.1% to 4.9%). A significant linear relationship was found between patient preoperative hypertensive status and the combined 30-day stroke and death rate (trend odds ratio, 3.5; 95% CI, 1.6 to 7.7). No association was seen between any main outcome measures and hospital volume (<10 CEAs versus > or = 10 CEAs). Four patients underwent surgery outside guideline recommendations (CEA performed for either < or = 30% stenosis or occluded carotid artery).
CONCLUSION: This first comprehensive state-wide audit confirms that Australian surgeons achieve 30-day outcomes comparable with international benchmarks.
Authors:
Sandy Middleton; Neil Donnelly;
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  36     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-03     Completed Date:  2002-07-31     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:  62-9     Citation Subset:  IM    
Affiliation:
Needs Assessment & Health Outcomes Unit, Central Sydney Area Health Service, Sydney, New South Wales, Australia.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Benchmarking*
Carotid Artery Diseases / complications,  mortality,  surgery
Carotid Artery, Common / pathology,  surgery
Endarterectomy, Carotid*
Female
Follow-Up Studies
Hospital Mortality
Humans
Male
Management Audit
New South Wales / epidemiology
Postoperative Complications / etiology,  mortality
Prospective Studies
Reproducibility of Results
Risk Factors
Sex Factors
Stroke / etiology,  mortality
Survival Analysis
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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