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(Stroke. 2003;34:592.)
© 2003 American Heart Association, Inc.

Letters to the Editor

Potential Pitfalls in Applying Carotid Endarterectomy Perioperative Mortality and Morbidity Rates

Department of Endocrinology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia

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

To the Editor:

Recent guidelines for carotid endarterectomy (CE) recommend a requirement for very low perioperative complication rates (3.0%).¹ For symptomatic patients, with 70% to 90% stenoses, however, a CE stroke perioperative complication rate of 6.0% is likely to show a 16.5% decrease in risk for nonfatal stroke or death at 2 years.² The 2 major trials, the NASCET² and ECST,³ had perioperative complication rates of 5.8 (95% CI, 3.3 to 8.3) and 9.1% (95% CI, 6.1 to 12.0), respectively. There was no significant difference between CE complication rates for the 2 trials (P=0.14), and the NASCET rate is significantly higher (P<0.01) than the present recommendation of 3.0%. The importance of the CE complication rate, with respect to any net patient benefit, has prompted calls for the routine availability of relevant data on both surgeons and hospitals. This is particularly relevant given comments that CE perioperative complication rates quoted for published studies may be atypically low due to a reporting bias, and that analysis of Medicare data finds CE 30-day complication rates that range between 5% and 11%.⁴

If we assume that the true underlying rate for CE perioperative complications is 6.0%, and that figure would ultimately be achieved by an institution, if it performed a large enough series of CE procedures (n=1000), the expected range of perioperative complications, in smaller random samples, can be calculated using a technique referred to as Monte Carlo sampling.⁵ Accordingly, when the recommended sample size of 100 is used, the results show . . . [Full Text of this Article]