This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Feasby, T. E. Articles by Findlay, J. M. Search for Related Content PubMed PubMed Citation Articles by Feasby, T. E. Articles by Findlay, J. M. Related Collections Health policy and outcome research Carotid endarterectomy Carotid Stenosis Primary and Secondary Stroke Prevention

(Stroke. 2001;32:2417.)
© 2001 American Heart Association, Inc.

Original Contributions

Geographic Variation in the Rate of Carotid Endarterectomy in Canada

Thomas E. Feasby, MD;; Hude Quan, MD, PhD William A. Ghali, MD, MPH

From the Departments of Clinical Neurosciences (T.E.F.), Community Health Sciences (H.Q., W.A.G.), and Medicine (W.A.G.), Faculty of Medicine, University of Calgary, and the Calgary Health Region, Calgary, Alberta, Canada.

Correspondence to Dr Thomas E. Feasby, Department of Clinical Neurosciences, Foothills Hospital, 1403 29th St NW, Calgary, AB, Canada T2N 2T9. E-mail feasby{at}ucalgary.ca

Background and Purpose—— Carotid endarterectomy (CEA) is an important method of stroke prevention, but its usage in Canada is not well known. The indications for CEA have been well informed by the recent clinical trials, but the impact of this information on the rate and regional variation in the rate of CEA is unknown. This study sought to determine the rate and the regional variation in the rate of CEA in Canada, its provinces, and census divisions for 1994–1997.

Methods—— Discharge data from all hospitals in Canada except Quebec were obtained from the Canadian Institute for Health Information for 1994–1997 and were searched for CEA by residential site. Rates and variations in rates were calculated.

Results—— The national age- and sex-adjusted rate per 100 000 people of CEA for those aged 40 years rose from 31.7 in 1994 to 40.5 in 1997. Provincial rates in 1997 varied from a low of 25.7 in Saskatchewan to high of 82.8 in Prince Edward Island. The census division rates varied even more, from a low of 0 in several divisions to a high of 179.

Conclusions—— The recent slight increase in CEA rates may reflect the release of new efficacy results for CEA, especially for asymptomatic carotid stenosis, but the rates are still far below US levels. The marked regional variation in rates may reflect differing views on the appropriateness of indications such as asymptomatic carotid stenosis for CEA and the inconsistency of published clinical practice guidelines.

Editorial Comment

J. Max Findlay, MD, PhD; Guest Editor

This article has been cited by other articles:

				M. L. Forte, B. A. Virnig, R. L. Kane, S. Durham, M. Bhandari, R. Feldman, and M. F. Swiontkowski Geographic Variation in Device Use for Intertrochanteric Hip Fractures J. Bone Joint Surg. Am., April 1, 2008; 90(4): 691 - 699. [Abstract] [Full Text] [PDF]

				A. Garland, Z. Shaman, J. Baron, and A. F. Connors Jr. Physician-attributable Differences in Intensive Care Unit Costs: A Single-Center Study Am. J. Respir. Crit. Care Med., December 1, 2006; 174(11): 1206 - 1210. [Abstract] [Full Text] [PDF]

				A. Garland Improving the ICU: Part 1 Chest, June 1, 2005; 127(6): 2151 - 2164. [Abstract] [Full Text] [PDF]

				J. Kennedy, H. Quan, W. A. Ghali, and T. E. Feasby Variations in rates of appropriate and inappropriate carotid endarterectomy for stroke prevention in 4 Canadian provinces Can. Med. Assoc. J., August 31, 2004; 171(5): 455 - 459. [Abstract] [Full Text] [PDF]

				T. E. Feasby, H. Quan, and W. A. Ghali Hospital and Surgeon Determinants of Carotid Endarterectomy Outcomes Arch Neurol, December 1, 2002; 59(12): 1877 - 1881. [Abstract] [Full Text] [PDF]