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Risk of carotid endarterectomy in the elderly
E S Fisher1, D J Malenka, N A Solomon
1Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755.
American Journal of Public Health
|December 1, 1989
Summary
Operative mortality for carotid endarterectomy increases with age. Patients undergoing this procedure at low-volume hospitals face a significantly higher risk of death within 30 days.
Area of Science:
- Vascular Surgery
- Health Services Research
- Geriatric Medicine
Background:
- Carotid endarterectomy is a common surgical procedure to prevent stroke.
- Understanding operative mortality and its determinants is crucial for patient safety and healthcare policy.
Purpose of the Study:
- To describe operative mortality for carotid endarterectomy in elderly Medicare beneficiaries.
- To investigate the association between hospital volume and 30-day mortality for this procedure.
Main Methods:
- Retrospective analysis of Medicare claims data from 1984-1985.
- Inclusion of 2,089 New England residents aged 65 and older who underwent carotid endarterectomy.
- Statistical analysis of mortality rates stratified by age and hospital procedure volume.
Main Results:
- Thirty-day mortality risk increased with age, ranging from 1.1% for ages 65-69 to 4.7% for those over 80.
- Approximately 80% of procedures were performed at low-volume hospitals (≤40 carotid endarterectomies/year).
- Patients treated at low-volume hospitals had an adjusted 2.8-fold increased odds of 30-day mortality compared to those at high-volume hospitals.
Conclusions:
- Age is a significant factor influencing operative mortality after carotid endarterectomy.
- Hospital procedure volume is a critical determinant of patient outcomes, with lower volume associated with higher mortality.
- These findings highlight the importance of hospital volume in carotid endarterectomy outcomes and suggest potential for quality improvement through centralization or volume thresholds.