Variability in carotid endarterectomy at a single medical center: an outcome and cost analysis
Sibu P Saha1, Peter M Rodgers-Fischl, David J Minion
1Department of Surgery, University of Kentucky, Lexington, Kentucky.
Insights
Carotid endarterectomy (CEA) techniques vary widely. This study found no significant differences in cost or short-term outcomes between shunt and no-shunt procedures, despite variations in utilization.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Health Services Research
Background:
- Carotid endarterectomy (CEA) is a proven stroke prevention surgery.
- Significant variability exists in CEA surgical techniques.
- Understanding technique variability impacts cost and patient outcomes.
Purpose of the Study:
- To analyze technique variability in carotid endarterectomy (CEA).
- To assess the impact of shunt utilization on cost and short-term outcomes.
- To identify surgeon-specific variations in CEA procedures.
Main Methods:
- Retrospective chart review of 349 patients undergoing 374 CEAs.
- Analysis of shunt and patch utilization across surgeons.
- Comparison of operative time, length of stay, cost, and in-hospital mortality between shunt and no-shunt groups.
Main Results:
- Shunt utilization varied significantly by surgeon (3% to 94%).
- Shunt placement increased operative time by ~1.4 hours and length of stay by 1.7 days.
- No significant difference in procedure cost or in-hospital mortality between shunt and no-shunt groups.
Conclusions:
- CEA technique variability, particularly shunt use, does not significantly impact short-term outcomes or cost.
- Standardization of CEA techniques may not be necessary based on cost and short-term outcomes.
- Further research could explore long-term outcomes and patient-specific factors influencing technique choice.
Abstract:
Carotid endarterectomy (CEA) is a common surgical procedure. Its efficacy in the prevention of stroke has been proven by multiple clinical trials including North American Symptomatic Carotid Endarterectomy Trial and Asymptomatic Carotid Atherosclerosis Study. Currently, there is a wide variability in the technique of this operation. This study was performed to determine the variability of CEA at the University of Kentucky Medical Center with a focus on cost and short-term outcome. We reviewed the charts of a consecutive series of 349 patients undergoing CEA at our institution. We analyzed the variability in shunt used across surgeons, intraoperative variables, cost, and outcome. Data on 374 procedures on 349 patients who underwent CEA showed shunt utilization varied significantly by surgeon from 3 to 94%. Patch utilization also varied significantly by surgeon. Two in-hospital deaths occurred in the shunt group (1.3%) and none in the no-shunt group. Shunt placement was associated with 1 hour 24 minutes increase in operative time from 2 hours 3 minutes in the no-shunt group to 3 hours 27 minutes in the shunt group (t test, p < 0.01). Shunt placement was associated with a 1.74-day increase in length of stay, from 2.97 days in the no-shunt group to 4.71 days in the shunt group. There was no significant difference in the cost of procedure in these two groups: no-shunt $11,510 ± $3,977, shunt group $11,479 ± $4,030. This study showed no significant difference in cost or outcome between various techniques.
