on October 23, 2008
Published online before print October 23, 2008, doi: 10.1161/STROKEAHA.108.524785
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Submitted on May 2, 2008
From the Departments of Internal Medicine and Clinical Sciences (E.A.H.), University of Texas Southwestern Medical Center, Dallas, TX; the Departments of Neurology (S.T.) and Health Policy (J.J.W.), Mount Sinai School of Medicine, New York, NY; the Department of Surgery (C.R., T.S.R.), New York University School of Medicine, New York, NY; and the Joint Commission on Accreditation of Healthcare Organization (M.R.C.), Oakbrook Terrance, Ill. * To whom correspondence should be addressed. E-mail: Ethan.Halm{at}UTsouthwestern.edu.
Background and Purpose—The benefit of carotid endarterectomy is heavily influenced by the risk of perioperative death or stroke. This study developed a multivariable model predicting the risk of death or stroke within 30 days of carotid endarterectomy. Methods—The New York Carotid Artery Surgery (NYCAS) Study is a population-based cohort of 9308 carotid endarterectomies performed on Medicare patients from January 1998 through June 1999 in New York State. Detailed clinical data were abstracted from medical charts to assess sociodemographic, neurological, and comorbidity risk factors. Deaths and strokes within 30 days of surgery were confirmed by physician overreading. Multivariable logistic regression was used to identify independent patient risk factors. Results—The 30-day rate of death or stroke was 2.71% among asymptomatic patients with no history of stroke/transient ischemic attack (TIA), 4.06% among asymptomatic ones with a distant history of stroke/TIA, 5.62% among those operated on for carotid TIA, 7.89% of those with stroke, and 13.33% in those with crescendo TIA/stroke-in-evolution. Significant multivariable predictors of death or stroke included: age Conclusions—Several sociodemographic, neurological, and comorbidity risk factors predicted perioperative death or stroke after carotid endarterectomy. This information may help inform decisions about appropriate patient selection, assessments about the impact of different surgical processes of care on outcomes, and facilitate comparisons of risk-adjusted outcomes among providers.
Accepted on May 27, 2008
Risk Factors for Perioperative Death and Stroke After Carotid Endarterectomy. Results of the New York Carotid Artery Surgery Study
Ethan A. Halm MD, MPH*;
80 years (OR, 1.30; 95% CI, 1.03 to 1.64), nonwhite (OR, 1.83; 1.23 to 2.72), admission from the emergency department (OR, 1.95; 1.50 to 2.54), asymptomatic but distant history of stroke/TIA (OR, 1.40; 1.02 to 1.94), TIA as an indication for surgery (OR, 1.81; 1.39 to 2.36), stroke as the indication (OR, 2.40; 1.74 to 3.31), crescendo TIA/stroke-in-evolution (OR, 3.61; 1.15 to 11.28), contralateral carotid stenosis 50% (OR, 1.44; 1.15 to 1.79), severe disability (OR, 2.94; 1.91 to 4.50), coronary artery disease (OR, 1.51; 1.20 to 1.91), and diabetes on insulin (OR, 1.55; 1.10 to 2.18). Presence of a deep carotid ulcer was of borderline significance (OR, 2.08; 0.93 to 4.68).
Key words: carotid endarterectomy • complications • outcomes • prognosis • risk factors
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