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Auditing carotid endarterectomy: a regional experience
J Max Findlay1, Linda Nykolyn, Tracey B Lubkey
1Division of Neurosurgery, University of Alberta, Clinical Quality Resource and Risk Management Department, Capital Health Authority, Alberta, Canada.
Summary
Regular audits and feedback significantly improved carotid endarterectomy (CEA) appropriateness and reduced complications. General practitioners referring patients directly to surgeons need to be aware of current CEA guidelines for optimal stroke prevention.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Public Health
Background:
- Randomized controlled trials confirm carotid endarterectomy (CEA) efficacy in stroke prevention, leading to increased utilization.
- Audits were conducted to assess patient selection and complication rates for CEA in a specific region compared to trial data.
Purpose of the Study:
- To evaluate the appropriateness of carotid endarterectomy (CEA) indications and complication rates over time.
- To assess the impact of regular auditing and feedback on surgical performance and patient outcomes.
Main Methods:
- Four sequential audits of CEAs performed between 1994 and 2000 were conducted.
- Patient selection criteria were categorized as appropriate, uncertain, or inappropriate based on stenosis severity and patient stability.
- Complication rates (stroke and death) and referral sources were analyzed across the audit periods.
Main Results:
- Initial audits showed low rates of appropriate CEA (33%), with a high proportion of asymptomatic patients (40%).
- Subsequent audits demonstrated significant improvements: appropriate indications increased to 58%, inappropriate operations were eliminated, and complication rates decreased from 5.2% to 2.3%.
- General practitioners were the primary referral source (69%), particularly for asymptomatic patients undergoing CEA.
Conclusions:
- Regular auditing and feedback effectively improved the quality of carotid endarterectomy (CEA) performance and reduced associated risks.
- Educating general practitioners on current CEA guidelines is crucial, given their significant role in patient referrals.