|Race as a predictor of morbidity, mortality, and neurologic events after carotid endarterectomy.|
|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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|Type: Comparative Study; Journal Article; Multicenter Study Date: 2013-01-30|
|Title: Journal of vascular surgery Volume: 57 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2013 May|
|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|
|Languages: eng Pagination: 1325-30 Citation Subset: IM|
|Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.|
|APA/MLA Format Download EndNote Download BibTex|
Aged, 80 and over
Carotid Artery Diseases / ethnology, mortality, surgery*
Endarterectomy, Carotid / adverse effects*, mortality*
European Continental Ancestry Group*
Health Status Disparities*
Heart Arrest / ethnology, mortality
Length of Stay
Pneumonia / ethnology, mortality
Postoperative Hemorrhage / ethnology, mortality, therapy
Stroke / ethnology*, mortality*
United States / epidemiology
J Vasc Surg. 2013 Nov;58(5):1444
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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