Variation in carotid endarterectomy mortality in the medicare population trial hospitals, volume, and patient characteristics.
Context. - The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Study (ACAS) demonstrated the efficacy of carotid endarterectomy (CEA) in reducing the risk of stroke and death in selected patients when surgery was performed in institutions whose participation depended on demonstrated excellence.
Thirty-day mortality rates in the trials were very low : 0.6% in NASCET and 0.1% in ACAS.
- To assess perioperative mortality among Medicare patients undergoing CEA in all nonfederal institutional settings.
- Retrospective national cohort study.
Setting and Patients
- All 113 300 Medicare patients undergoing CEA during 1992 and 1993 in « trial hospitals » (those participating in NASCET and ACAS, n=86) and « nontrial hospitals » (all other nonfederal institutions performing CEAs, n=2613).
Nontrial hospitals were stratified into terciles based on volume of CEAs performed.
Main Outcome Measures
- Crude and adjusted perioperative (30 day) mortality rates.
- The perioperative mortality rate was 1.4% (95% confidence interval [CI], 1.2% - 1.7%) at trial hospitals ; mortality in nontrial hospitals was higher :
The perioperative mortality rate was 1.4% (95% confidence interval [CI], 1.2% - 1.7%) at trial hospitals ;
1.7% (95% CI, 1.6% - 1.8%) (high volume) ;
1.9% (95% CI, 1.7% - 2.1%) (average volume) ;
2.5% (95% CI, 2.0% - 2.9%) (low volume) ;
(P for trend,<. 001). (...)
Mots-clés Pascal : Athérosclérose, Etude cohorte, Carotide, Endartériectomie, Facteur risque, Peropératoire, Mortalité, Rétrospective, Homme, Etats Unis, Amérique du Nord, Amérique, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Chirurgie
Mots-clés Pascal anglais : Atherosclerosis, Cohort study, Carotid, Endarteriectomy, Risk factor, Intraoperative, Mortality, Retrospective, Human, United States, North America, America, Cardiovascular disease, Vascular disease, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0236611
Code Inist : 002B25F. Création : 11/09/1998.