Carotid endarterectomy in the elderly population: a statewide experience

The practice of carotid endarterectomy (CEA) was examined in all Medicare patients undergoing operation in the state of Kentucky during 1983 and during the first 6 months of 1984. CEA was performed 738 times on 705 patients in 1983 by 98 surgeons in 41 hospitals. The average age of patients was 71 years, and only 15% had no symptoms of carotid disease. The stroke rate was 3.7%, and the combined stroke and mortality rate was 5.7%. In a follow-up period in 1984, the combined stroke and mortality rate was 4.3%. Patients who showed no symptoms of carotid disease had a combined stroke and mortality rate of 2.8%. Surgeons performing fewer than three CEAs per year had a tendency toward a higher complication rate than had surgeons performing more than 12 CEAs a year. Most stroke complications appeared as isolated events and did not seem to represent a practice pattern based on our follow-up into 1984.