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(Stroke. 2003;34:2573.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Identifying Risk Factors for Perioperative Outcomes After Carotid Endarterectomy: The Story Continues

School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Given that the perioperative stroke and death rate associated with carotid endarterectomy (CEA) ranges from 2% to 8%,^1–5 identification of subgroups of patients with differential risk is critically important. Given this relatively high average rate, an absolute difference of 2% to 4% in the perioperative risk of CEA could easily occur and may be sufficient to change the positive overall efficacy of CEA to negative. The growing literature^5–11 suggests that substantial differences by patient characteristics exist in perioperative risk associated with CEA.

The study by Tu and colleagues¹¹ is an important contribution to our understanding of the perioperative risk associated with CEA, reporting risk factors for 30-day stroke and death associated with CEA performed in Ontario, Canada, from 1994 through 1997. This report is unique for several reasons. The first has to do with statistical power. The proportion of patients suffering events is relatively low, so a very large sample size is required for there to be a sufficient number of patients with events to permit appropriate statistical analyses to identify risk factors with reasonable precision. With a sample size of >6000 procedures and 361 events, the present study is among the largest studies to date, therefore providing the most precise estimates of the impact of risk factors on perioperative stroke and death. Second, although the study was retrospective, a major focus of effort was the standardization of procedures for chart abstraction and assessment of risk factors; thus, this data collection effort was likely more robust than many surgeon- or institution-specific retrospective . . . [Full Text of this Article]