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Audit of long-term mortality and morbidity outcomes for carotid endarterectomy
Sandy Middleton1, Neil Donnelly, John Harris
1Division of Population Health, Central Sydney Area Health Service, School of Public Health, University of Sydney.
Insights
Australian patients undergoing carotid endarterectomy (CEA) face high long-term vascular mortality. Post-surgery, survivors require coordinated vascular risk management to improve health outcomes and reduce stroke incidence.
Area of Science:
- Vascular Surgery
- Public Health
- Outcomes Research
Background:
- Limited Australian data exists on long-term mortality and quality-of-life post-carotid endarterectomy (CEA).
- Understanding post-CEA outcomes is crucial for patient management and healthcare planning.
Purpose of the Study:
- To determine the long-term mortality rate and causes of death following CEA in an Australian cohort.
- To assess the quality-of-life and subsequent health status of CEA survivors.
Main Methods:
- A retrospective cohort study of 238 patients who underwent CEA in 1995.
- Mortality data was analyzed over four years post-procedure.
- Surviving patients (n=162) completed the MOS SF-36 survey to assess health status.
Main Results:
- 18.5% of patients died within four years of CEA, with 61.4% of deaths attributed to vascular causes.
- 6.2% of survivors experienced a non-fatal stroke within the four-year follow-up period.
- Physical Functioning and Role Physical scores on the MOS SF-36 were significantly associated with age in survivors.
Conclusions:
- Patients undergoing CEA have a substantial risk of late vascular death.
- Effective discharge planning and ongoing vascular risk factor management are essential for CEA patients.
- Further research into optimizing post-CEA care pathways is warranted.
Abstract:
There have been no Australian studies of long-term mortality status and cause of death after carotid endarterectomy (CEA) or, for survivors, quality-of-life. We first determined rate and cause of death for a cohort of patients four years after CEA. Surviving patients were surveyed to ascertain health status, using MOS SF-36. Of 238 patients who underwent CEA in our health service in 1995, 44 (18.5%) had died within four years. The majority of deaths (61.4%) were attributable to vascular causes. Of the surviving 162 patients (survey response fraction 90%), 10 (6.2%) subsequently had suffered a non-fatal stroke in the four years following their CEA. With respect to health status, Physical Functioning scores differed significantly by age (t = 2.65, df = 149, P = 0.01) as did Role Physical scores (t = 2.10, df = 142, P = 0.04). We conclude that patients undergoing CEA are at high risk of dying from vascular causes, inviting concerted efforts in discharge planning to co-ordinate optimal vascular risk factor management.
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