US nationwide trends in carotid revascularization: hospital outcome and predictors of outcome from 1998 to 2007
Article first published online: 9 JUL 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Acta Neurologica Scandinavica
Volume 129, Issue 2, pages 85–93, February 2014
How to Cite
US nationwide trends in carotid revascularization: hospital outcome and predictors of outcome from 1998 to 2007. Acta Neurol Scand 2014: 129: 85–93. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., , .
- Issue published online: 9 JAN 2014
- Article first published online: 9 JUL 2013
- Manuscript Accepted: 4 JUN 2013
- carotid stenosis;
- carotid angioplasty and stenting;
- carotid endarterectomy
The goals of the study were to assess US nationwide trends in hospital outcome following carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) and to determine potential predictors of outcome.
The Nationwide Inpatient Sample, constituting a 20% representative and stratified sample of non-federal US hospitals, was analyzed retrospectively from years 1998 to 2007.
The annual number of CEA decreased (137,877–111,658) and increased for CAS (2318–14,415). Inhospital mortality following CEA decreased from 0.4% to 0.3% (P < 0.001), whereas long-term facility (LTF) discharge increased from 8.2% to 10.5% (P < 0.001). Discharge outcome improved for CAS in both categories (mortality 2–0.5%; LTF discharge 10.7–8.3%; both P < 0.001). The trend analysis revealed an increase in patient age and a worsening comorbid profile over time. Age, women, length of stay, atrial fibrillation, and carotid stenosis with infarction were important determinants of unfavorable hospital outcome.
From a nationwide practice perspective, the number of carotid revascularizations fell by 10%. CEA has resulted in stable hospital mortality rates. Meanwhile, CAS has been increasingly utilized with overall improvement in short-term outcome. Our results further suggest a decrease in the number of patients with treatment-eligible carotid disease over time. However, the increasing prevalence of high-risk comorbidity in the aging population may pose a challenge to revascularization strategies.