The effect of institutional case volume on post-operative outcomes after endarterectomy and stenting for symptomatic carotid stenosis.
Publication/Presentation Date
9-1-2024
Abstract
OBJECTIVE: To investigate the effects of yearly institutional case volume for carotid endarterectomy (CEA) and stenting (CAS) among symptomatic carotid stenosis patients on the rates of postoperative stroke and inpatient mortality.
MATERIALS AND METHODS: Patients with prior stroke ("symptomatic") undergoing CEA or CAS during an inpatient stay were identified from the National Inpatient Sample for years 2012-2015. The primary variable was volume of CEA or CAS performed annually by each institution. The primary outcome was a composite variable for in-hospital death or postoperative stroke.
RESULTS: A total of 5,628 patients with symptomatic carotid stenosis underwent CEA, while 245 underwent CAS. In the symptomatic CEA population, 519 (9.2 %) patients experienced postoperative stroke or mortality, and were more likely to be treated at centers with a lower yearly institutional volume (median 10 [IQR 5-15] versus 10 [7-20] cases, p < 0.001). In the symptomatic CAS population, 32 (13.1 %) patients experienced stroke or mortality, and these patients were also more likely to undergo treatment at hospitals with a lower yearly institutional volume (median 5 [IQR 5-7] versus 5 [5-10] cases, p = 0.044). Thresholds for yearly institutional volume found differences in adverse outcome between 0-9, 10-29, and ≥30 cases/year (11.7 % vs 8.4 % vs 6.0 %, p < 0.001) for CEA, and differences in postoperative stroke between 0-9 and ≥10 cases/year for CAS (11.0 % vs 1.4 %, p = 0.028).
CONCLUSIONS: Hospitals performing higher volumes of CEA or CAS have fewer postoperative strokes. The threshold reported herein is ≥30 CEA procedures or ≥10 CAS procedures annually for appreciably improved outcomes.
Volume
33
Issue
9
First Page
107828
Last Page
107828
ISSN
1532-8511
Published In/Presented At
Patel, P. D., Khanna, O., Lan, M., Baldassari, M., Momin, A., Mouchtouris, N., Tjoumakaris, S., Gooch, M. R., Rosenwasser, R. H., Farrell, C., & Jabbour, P. (2024). The effect of institutional case volume on post-operative outcomes after endarterectomy and stenting for symptomatic carotid stenosis. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 33(9), 107828. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107828
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
38908611
Department(s)
Administration and Leadership
Document Type
Article