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Provincial carotid endarterectomy outcomes
Thomas E Feasby1, Hude Quan, William A Ghali
1Department of Clinical Neurosciences, University of Calgary and the Calgary Health Region, Calgary, Alberta, Canada.
Summary
Carotid endarterectomy (CE) outcomes in Canada are generally good and improved over four years. However, significant provincial variations in adverse events suggest regionalization may enhance patient care and outcomes.
Area of Science:
- Vascular Surgery
- Health Services Research
- Outcomes Measurement
Background:
- Performance improvement requires outcome measurement.
- Carotid endarterectomy (CE) is a common surgical procedure.
- Understanding national and provincial CE outcomes is crucial.
Purpose of the Study:
- To measure national and provincial outcomes of carotid endarterectomy (CE).
- To identify and explain provincial variations in CE adverse events.
Main Methods:
- Analysis of a Canada-wide administrative hospital discharge database (excluding Quebec) from 1994-1997.
- Inclusion of 14,268 patients undergoing CE.
- Logistic regression used for risk adjustment to assess in-hospital stroke and/or death rates.
Main Results:
- Overall in-hospital death rate was 1.3%.
- Combined stroke and/or death rate was 4.1%.
- Saskatchewan and Newfoundland showed significantly higher risk-adjusted adverse event rates.
Conclusions:
- Carotid endarterectomy (CE) outcomes in Canada are favorable and demonstrated improvement over the study period.
- Significant provincial disparities in CE outcomes were identified.
- Regionalization of CE services may be necessary to increase surgeon/hospital case volumes and improve outcomes.