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US nationwide trends in carotid revascularization: hospital outcome and predictors of outcome from 1998 to 2007

Authors

  • J. H. Choi,

    1. Department of Neurology, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
    2. Clinical Sciences, Janus Head Consulting, LLC, Mineola, NY, USA
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  • J. Pile-Spellman,

    1. Neurological Surgery P.C., Lake Success, NY, USA
    2. Neurosurgical Services, Winthrop University Hospital, Mineola, NY, USA
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  • J. L. Brisman

    Corresponding author
    1. Neurological Surgery P.C., Lake Success, NY, USA
    2. Neurosurgical Services, Winthrop University Hospital, Mineola, NY, USA
    • J. Brisman, Cerebrovascular and Endovascular Neurosurgery, Winthrop University Hospital, 1991 Marcus Avenue, Suite 108, Lake Success, NY 11042, USA

      Tel.: (516) 442-2250

      Fax: (516) 255-6230

      e-mail: jbrisman@nspc.com

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Abstract

Objectives

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.

Methods

The Nationwide Inpatient Sample, constituting a 20% representative and stratified sample of non-federal US hospitals, was analyzed retrospectively from years 1998 to 2007.

Results

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.

Conclusion

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.

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