Document Detail

Race as a predictor of morbidity, mortality, and neurologic events after carotid endarterectomy.
MedLine Citation:
PMID:  23375438     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Racial disparities in the outcomes of patients undergoing carotid endarterectomy (CEA) have been reported. We sought to examine the contemporary relationship between race and outcomes and to report postdischarge events after CEA.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were reviewed to identify all CEAs performed from 2005 to 2010 by vascular surgeons. The influence of race on outcomes was examined. Multivariate analysis was performed using variables found to be significant on bivariate analysis. The primary outcomes were stroke and mortality. Secondary outcomes were other 30-day complications, including postdischarge events.
RESULTS: CEA was performed on 29,114 white patients (95.7%) and on 1316 black patients (4.3%); the overall stroke and mortality rates were 1.65% and 0.7%, respectively. The stroke rate was 1.6% for whites and 2.5% blacks (P = .009). The 30-day mortality rate was 0.7% for whites and 1.4% for blacks (P = .002). There was a longer operating time (P < .001) and total length of stay (P < .001), more postoperative pneumonias (P = .049), unplanned intubations (P < .001), ventilator dependence (P < .001), cardiac arrests (P < .001), bleeding requiring transfusions (P = .024), and reoperations within 30 days (P = .021) among black patients. Multivariate logistic regression modeling identified black race as an independent risk factor for 30-day mortality (odds ratio, 1.9; P = .007). Black patients also had a greater proportion of in-hospital deaths than white patients (73.7% vs 43.1%; P = .01). There was no between-group difference in the rate of postdischarge strokes. Thirty-six percent of all strokes occurred after discharge at a mean of 8.3 days, and 54.3% of deaths occurred after discharge at a mean of 11 days.
CONCLUSIONS: Black race is an independent risk factor for 30-day mortality after CEA. A significant proportion of strokes and deaths occur after discharge in both racial groups evaluated.
Hilary A Brown; Michael C Sullivan; Richard G Gusberg; Alan Dardik; Julie Ann Sosa; Jeffrey E Indes
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2013-01-30
Journal Detail:
Title:  Journal of vascular surgery     Volume:  57     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-22     Completed Date:  2013-06-17     Revised Date:  2013-12-09    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1325-30     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
African Americans*
Aged, 80 and over
Blood Transfusion
Carotid Artery Diseases / ethnology,  mortality,  surgery*
Chi-Square Distribution
Endarterectomy, Carotid / adverse effects*,  mortality*
European Continental Ancestry Group*
Health Status Disparities*
Heart Arrest / ethnology,  mortality
Intubation, Intratracheal
Length of Stay
Logistic Models
Middle Aged
Multivariate Analysis
Odds Ratio
Patient Discharge
Pneumonia / ethnology,  mortality
Postoperative Hemorrhage / ethnology,  mortality,  therapy
Respiration, Artificial
Risk Assessment
Risk Factors
Stroke / ethnology*,  mortality*
Time Factors
Treatment Outcome
United States / epidemiology
Comment In:
J Vasc Surg. 2013 Nov;58(5):1444   [PMID:  24160317 ]
J Vasc Surg. 2013 Nov;58(5):1444-5   [PMID:  24160318 ]

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

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