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Carotid revascularization treatment is shifting to low volume centers

Waleed Brinjikji1, David F Kallmes2, Giuseppe Lanzino2

  • 1Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.

Journal of Neurointerventional Surgery
|April 10, 2014
PubMed

Insights

Treatment for carotid stenosis is shifting to lower-volume centers, despite high-volume centers demonstrating better patient outcomes and lower complication rates for carotid revascularization procedures.

Area of Science:

  • Vascular Surgery
  • Health Services Research
  • Neurosurgery

Background:

  • The increasing number of endovascular and surgical specialists in the USA may lead to carotid revascularization procedures being performed at lower-volume hospitals.
  • This trend raises concerns about patient safety and quality of care.

Purpose of the Study:

  • To analyze trends in carotid stenosis treatment at high-volume centers within the USA.
  • To compare patient outcomes based on hospital procedure volume.

Main Methods:

  • Utilized the Nationwide Inpatient Sample (NIS) database to examine carotid revascularization trends from 2005 to 2011.
  • Defined high-volume centers by specific annual procedure counts for combined endarterectomy/stenting, carotid endarterectomy, and carotid stenting.
  • Compared in-hospital mortality, discharge to long-term care, intracranial hemorrhage, and postoperative stroke rates between high- and low-volume centers.

Main Results:

  • Over 181,000 patients were analyzed; 34.9% were treated at high-volume centers.
  • The proportion of carotid revascularization procedures at high-volume centers decreased from 38.3% (2005-2006) to 30.2% (2010-2011).
  • Patients treated at low-volume centers experienced significantly higher rates of discharge to long-term facilities compared to those at high-volume centers.

Conclusions:

  • A concerning trend shows a decreasing proportion of carotid stenosis patients treated at high-volume centers between 2005 and 2011.
  • High-volume centers are associated with lower complication rates, highlighting the importance of procedural volume for patient outcomes.
Abstract

Keywords:
ComplicationEconomicsInterventionStent

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