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Comparison of carotid endarterectomy at high- and low-volume hospitals
1Foundation for Accountability, Oregon Health Science University, 9155 SW Barnes Rd, Suite 304, Portland, OR 97225, USA.
Background:
Population-based studies have demonstrated better outcomes for carotid endarterectomies at high-volume hospitals.
Methods:
This is a 2-year retrospective review of carotid procedures at two low-volume hospitals (n = 156) and one high-volume hospital (n = 404) in the metropolitan area of Portland, Oregon.
Results:
There were no significant differences in 30-day mortality and stroke rates for carotid endarterectomies when comparing low- and high-volume hospitals (P = 0.59). These were comparable rates despite the fact that the low-volume hospitals had significantly older patients (P <0.001), more smokers (P <0.001), more patients with an indication of a previous nondisabling stroke (P <0.01), and fewer patients who were asymptomatic (P <0.01).
Conclusion:
The regionalization of carotid endarterectomy into high-volume hospitals is not justified by the findings of this study. Carotid endarterectomy performed by well-trained, experienced surgeons in low-volume hospitals is a safe procedure.
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