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Published on: November 11, 2012
Carotid endarterectomy in community practice: surgeon-specific versus institutional results
Insights
Carotid endarterectomy for stroke prevention is effective when surgeons are skilled, not tied to specific hospitals. Individual surgeon expertise, not institutional factors, determines successful outcomes in community practice.
Area of Science:
- Vascular Surgery
- Neurology
- Public Health
Background:
- Carotid endarterectomy (CE) is a procedure to prevent stroke.
- CE efficacy depends on patient selection and surgical risk.
- Concerns exist about variations in CE outcomes across institutions.
Purpose of the Study:
- To evaluate the impact of individual surgeons versus institutions on carotid endarterectomy outcomes.
- To analyze a large series of consecutive CE cases performed by a limited number of surgeons across multiple hospitals.
Main Methods:
- Retrospective analysis of 566 consecutive carotid endarterectomy cases over twelve years.
- Procedures performed by two vascular surgeons across thirteen hospitals in a metropolitan area.
- Comparison of hospital-specific mortality, stroke incidence, and complication rates.
Main Results:
- Overall mortality was 0.5% and permanent stroke incidence was 1.6%.
- Outcomes did not significantly vary between the thirteen hospitals.
- Individual hospital surgical audit data showed significantly higher overall complication rates compared to the surgeons' reported outcomes.
Conclusions:
- Individual surgeon skill and practice patterns are the primary determinants of carotid endarterectomy efficacy.
- Institutional factors do not appear to significantly influence CE outcomes in community settings.
- Focusing on surgeon performance is crucial for optimizing stroke prevention through carotid endarterectomy.
Abstract:
The efficacy of carotid endarterectomy in preventing stroke is clearly related to appropriate patient selection and low surgical morbidity and mortality. It has been suggested that since results at some centers are better than nationwide statistics, perhaps the operation should be limited to those institutions. In this paper we present an experience with carotid endarterectomy over the past twelve years. These 566 consecutive cases were performed by two vascular surgeons in a large metropolitan area using thirteen different hospitals ranging from 150 to 500 beds. Our mortality of 0.5% and permanent stroke incidence of 1.6% did not vary significantly from hospital to hospital. Where the results of surgical audits were available from the individual hospitals, the overall complication rates were significantly higher. We conclude that individual surgeons, not institutions, determine the efficacy of carotid endarterectomy in community practice.
