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Published on: May 14, 2013
Carotid Endarterectomy versus Carotid Artery Stenting: No Difference in 30-Day Postprocedure Readmission Rates
Erin K Greenleaf1, David C Han1, Christopher S Hollenbeak2
1Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA.
Insights
Readmission rates after carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis are similar, around 10%. The choice between CEA and CAS does not significantly impact 30-day readmission rates or time to readmission.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Public Health
Background:
- Ischemic stroke is a leading cause of death and disability in the US, with carotid artery stenosis a significant contributing factor.
- Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established treatments for carotid artery stenosis, offering comparable patient outcomes.
- Data on readmission rates following CEA versus CAS is limited, prompting further investigation into potential differences.
Purpose of the Study:
- To compare 30-day readmission rates between patients undergoing CEA and CAS for carotid artery stenosis.
- To investigate potential differences in patient characteristics and reasons for readmission between the two procedures.
- To determine if the procedural choice influences time to readmission after intervention for carotid artery stenosis.
Main Methods:
- Analysis of 4,319 patients who underwent CEA (n=3,640) or CAS (n=679) in Pennsylvania in 2011 using the PHC4 database.
- Univariate analyses to compare patient demographics, comorbidities, and readmission outcomes between CEA and CAS groups.
- Logistic regression and Kaplan-Meier analysis to assess the impact of intervention type on 30-day readmission rates and time to readmission, controlling for confounders.
Main Results:
- Patients undergoing CEA and CAS differed in age, race, admission type, and comorbidities.
- The unadjusted 30-day readmission rate was 9.37% for CEA and 10.75% for CAS (P=0.26).
- After adjusting for patient and procedural factors, no statistically significant difference in 30-day readmission rates was observed between CEA and CAS (OR=1.13; P=0.39). Time to readmission was also similar (P=0.19).
Conclusions:
- Approximately 10% of patients experience readmission within 30 days following CEA or CAS for carotid artery stenosis.
- Despite baseline differences in patient populations, the choice between CEA and CAS does not appear to be associated with significantly different readmission rates or time to readmission.
- Complications related to the procedure accounted for less than 10% of primary readmission diagnoses for both CEA and CAS.
Background:
In the United States, ischemic stroke is a major cause of morbidity and mortality, precipitated by carotid artery stenosis in 1 of every 5 individuals who suffer a stroke. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are 2 proven means of intervening on this disease process, with similar patient outcomes. Little is known about the burden of readmission after each of these procedures. We hypothesized that no difference in readmission rates within 30 days would exist for these 2 procedures, in spite of baseline differences that might exist between the 2 patient populations.
Methods:
Using the Pennsylvania Health Care Cost Containment Council database, we identified 4,319 people who underwent CEA (n = 3,640) or CAS (n = 679) in Pennsylvania in 2011. Univariate analyses were performed to compare patient characteristics and outcomes, including reasons for readmission, between patients who underwent CEA and those who underwent CAS. Logistic regression was used to estimate the effect of intervention on 30-day readmission, after controlling for potential confounders. Time to readmission was analyzed using the Kaplan-Meier method.
Results:
Patients who underwent CEA and CAS differed in a few notable ways, including age, race, admission type, and comorbid conditions such as congestive heart failure, hemiplegia and paraplegia, and renal disease. The unadjusted rate of 30-day readmission was 9.37% for CEA and 10.75% for CAS (P = 0.26). After controlling for patient and procedure characteristics, differences between 30-day readmission rates were still not statistically significant (odds ratio = 1.13; P = 0.39). Finally, time to readmission was similar for those who underwent CEA and those who underwent CAS (P = 0.19). Complications associated with surgery comprised less than 10% of primary readmission diagnoses for both groups.
Conclusions:
Readmission rates after CEA and CAS for carotid artery stenosis are approximately 10%. In spite of differences between patients with carotid stenosis who are selected for endarterectomy and stenting, the choice of procedure does not appear to be associated with different readmission rates or time to readmission, even after controlling for patient characteristics.
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