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Association between Hospital Carotid Endarterectomy Procedure Volumes and In-Hospital Mortality in São Paulo State
1Universidade do Vale do Taquari - UNIVATES, Lajeado, RS, Brasil.
Insights
Higher hospital volume for carotid endarterectomy was linked to reduced in-hospital mortality in São Paulo. This association warrants further investigation, particularly regarding patient symptoms.
Area of Science:
- Vascular Surgery
- Health Services Research
- Epidemiology
Background:
- Previous research suggests a link between lower hospital procedure volume and increased mortality for carotid endarterectomy.
- Data specific to Brazil regarding this relationship are limited.
- Understanding this association is crucial for optimizing patient outcomes in Brazil.
Purpose of the Study:
- To investigate the association between hospital carotid endarterectomy procedure volume and in-hospital mortality in São Paulo, Brazil.
- To determine if hospital volume is an independent predictor of mortality after carotid endarterectomy.
Main Methods:
- Analysis of carotid endarterectomy data from the São Paulo State Hospital Information System (2015-2019).
- Hospitals categorized into low (1-10), medium (11-25), and high (≥26) annual procedure volume groups.
- Multiple logistic regression models employed to assess the impact of volume on in-hospital mortality.
Main Results:
- Crude in-hospital mortality was significantly lower in high-volume centers compared to low-volume centers (unadjusted OR for survival: 2.41).
- This translates to approximately 1.5 fewer deaths per 100 patients in high-volume settings.
- After adjusting for patient characteristics, the statistical significance of the association between volume and mortality was not maintained (OR: 1.69).
Conclusions:
- Higher volume carotid endarterectomy centers in São Paulo demonstrated an association with lower in-hospital mortality.
- Further research is needed to confirm these findings, considering factors like patient symptomatology.
- The results highlight the potential importance of hospital volume in carotid endarterectomy outcomes within the Brazilian healthcare context.
Background:
Previous studies indicate an inverse relationship between hospital volume and mortality after carotid endarterectomy. However, data at the level of Brazil are lacking.
Objectives:
To assess the relationship between hospital carotid endarterectomy procedure volumes and mortality in the state of São Paulo.
Methods:
Data from the São Paulo State Hospital Information System on all carotid endarterectomies performed between 2015 and 2019 were analyzed. Hospitals were categorized into clusters by annual volume of surgeries (1-10, 11-25, and ≥26). Multiple logistic regression models were used to determine whether the volume of carotid endarterectomy procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure.
Results:
Crude in-hospital mortality was nearly 60 percent lower in patients who underwent carotid endarterectomy at the highest volume hospitals than among those who underwent endarterectomy at the lowest volume hospitals (unadjusted OR of survival to hospital discharge, 2.41; 95% CI, 1.11-5.23; p = 0.027). Although this lower rate represents 1.5 fewer deaths per 100 patients treated, high-volume centers are more likely than low-volume centers to perform elective procedures, thus the analysis did not retain statistical significance when adjusted for admission character (OR, 1.69; 95% CI, 0.74-3.87; p = 0.215).
Conclusions:
In a contemporary Brazilian registry, higher volume carotid endarterectomy centers were associated with lower in-hospital mortality than lower volume centers. Further studies are needed to verify this relationship considering the presence of symptoms in patients.
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