Related Experiment Videos
Carotid endarterectomy. Review of 150 consecutive cases in two small community hospitals
Insights
Carotid endarterectomy outcomes in community hospitals were favorable, with low mortality and stroke rates. Surgeon collaboration and assistance were key factors in achieving these results despite a low procedure volume.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cardiovascular Surgery
Background:
- Carotid endarterectomy is a surgical procedure to remove plaque from carotid arteries.
- Previous studies suggest a high volume of procedures is necessary for optimal outcomes.
- Community hospital settings may present unique challenges for surgical outcomes.
Purpose of the Study:
- To evaluate the outcomes of carotid endarterectomies performed in community hospitals.
- To assess if a lower annual volume of carotid endarterectomies per surgeon impacts patient safety.
- To identify factors contributing to favorable outcomes in a low-volume setting.
Main Methods:
- Retrospective review of 150 consecutive carotid endarterectomies in 140 patients.
- Procedures performed by three neurosurgeons across two community hospitals over a 7-year period.
- Intraoperative monitoring using electroencephalography (EEG).
Main Results:
- Overall mortality rate was 1.3%; major/minor stroke and transient neurological dysfunction each occurred in 2.7% of patients.
- Preoperative symptoms included stroke (39.3%) and transient neurological dysfunction (43.3%); 17.3% were asymptomatic.
- Operative deaths (2) were due to myocardial infarction on postoperative day 2. Average procedures per surgeon/year was 10.
Conclusions:
- Favorable carotid endarterectomy outcomes (low mortality and stroke rates) can be achieved in community hospitals, even with lower annual procedure volumes per surgeon.
- Surgeon collaboration, with one neurosurgeon assisting another in nearly all cases, was a critical factor in achieving these results.
- This series challenges the notion that high procedural frequency is essential for maintaining low morbidity and mortality rates in carotid endarterectomy.
Abstract:
The authors have reviewed 150 consecutive carotid endarterectomies in 140 patients performed by three neurosurgeons. These were performed in two small community hospitals. There was an overall mortality rate of 1.3%; major or minor stroke was seen in 2.7% of patients and transient neurological dysfunction in 2.7%. Preoperative symptoms included major or minor stroke in 39.3% of patients and transient neurological dysfunction in 43.3%; 17.3% of patients were asymptomatic. The patients were continuously monitored intraoperatively with electroencephalography. There were two operative deaths, both related to myocardial infarction and both on the 2nd postoperative day. These statistics appear to compare favorably with those of series reported by major institutions. The average number of carotid endarterectomies per surgeon per year was 10. These were performed over a 7-year period (October, 1976, through November, 1983). Previous series have implied the need for higher frequency in performing the procedure to assure low morbidity and mortality rates. This series appears to offer evidence to the contrary. A key to these results has been that in 148 of the 150 operations, the primary surgeon has been assisted by one of the other two neurosurgeons. This affords the primary surgeon the benefit of excellent technical assistance, and also broadens the experience of the assisting surgeon, thereby allowing maximum experience from the small volume of cases.