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Declining morbidity and mortality of carotid endarterectomy. The Wake Forest University Medical Center experience
Insights
Carotid endarterectomy complication rates significantly decreased between 1978 and 1983 due to quality control measures. This study found low stroke and myocardial infarction rates in 389 procedures.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Previous reports indicated high morbidity (16%) and mortality (6%) for carotid endarterectomy.
- The need to assess the impact of quality control measures on surgical outcomes was identified.
Purpose of the Study:
- To determine the 30-day mortality and morbidity rates for stroke and myocardial infarction following carotid endarterectomy.
- To evaluate changes in complication rates compared to previous reports.
Main Methods:
- Retrospective review of 389 carotid endarterectomies performed between 1979 and 1983.
- Analysis of patient charts to identify perioperative stroke and myocardial infarction events.
Main Results:
- Combined morbidity was 2% and mortality was 2.3% for asymptomatic and symptomatic patients.
- Perioperative stroke rate (morbidity + mortality) was 2.6%, with 9 events ipsilateral to the surgery.
- Rates were significantly lower than the 16% morbidity and 6% mortality reported in 1978.
Conclusions:
- Quality control measures have led to dramatic and sustained reductions in carotid endarterectomy complication rates.
- Carotid endarterectomy is a safe procedure with low complication rates when appropriate quality controls are in place.
Abstract:
The 30-day mortality as well as morbidity for stroke and myocardial infarction were determined by review of the charts for every carotid endarterectomy (N = 389 operations on 356 patients) performed at Wake Forest University Medical Center from 1979 through 1983 to ascertain whether the 16% morbidity and 6% mortality documented in our previous report of 1978 had changed over time. For endarterectomies performed on asymptomatic patients (n = 155), major morbidity included 2 myocardial infarctions and 1 stroke (1.9%). There were 3 fatalities--2 myocardial infarctions and 1 stroke (1.9%). For the symptomatic group (n = 234), major morbidity was 2.1%, mortality 2.6%. The combined morbidity for asymptomatic and symptomatic carotid stenosis was 2%, mortality 2.3%. Perioperative stroke rate (morbidity plus mortality) was 2.6%, 9 ipsilateral to the carotid endarterectomy, suggesting distal embolism as its probable cause. We contend that quality control measures implemented to correct the unacceptable rates reported in 1978 have contributed to dramatic and sustained reductions in complication rates.