Published online before print April 10, 2003, doi: 10.1161/01.STR.0000066681.79339.E2
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(Stroke. 2003;34:1120.)
© 2003 American Heart Association, Inc.
Original Contributions |
Sex Differences in Carotid Endarterectomy Outcomes
Results From the Ontario Carotid Endarterectomy Registry
From the Institute for Clinical Evaluative Sciences (M.K.K., H.W., J.F., P.C.A., D.S.K, J.V.T.); Division of General Internal Medicine and Clinical Epidemiology and Women’s Health Program, University Health Network (M.K.K); Clinical Epidemiology and Health Care Research Program and Division of General Internal Medicine, Sunnybrook and Women’s College Health Sciences Centre (J.V.T.); Department of Medicine, University of Toronto (M.K.K., D.K., J.V.T.); Division of Vascular Surgery, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto (D.S.K.); and Department of Public Health Sciences, University of Toronto (M.K.K., P.C.A., D.K., J.V.T.), Toronto, Ontario, Canada.
Participating hospitals and surgeons in the Ontario Carotid Endarterectomy Registry are listed in the Appendix, which can be found online at http://stroke.ahajournals.org.Reprint requests to Dr Moira K. Kapral, Toronto General Hospital, 200 Elizabeth St, ENG-246, Toronto, Ontario, Canada M5G 2C4. E-mail moira.kapral{at}uhn.on.ca
Background and Purpose— The existing literature provides conflicting evidence on surgical risks of carotid endarterectomy in women compared with men. We used data from a large population-based carotid surgery registry to determine whether sex differences exist in the risk of perioperative complications from carotid endarterectomy.
Methods— We analyzed data from the Ontario Carotid Endarterectomy Registry, which contains data on all patients who underwent carotid endarterectomy in the province of Ontario between 1994 and 1997. We compared the risk of death or stroke at 30 days in women and men and used multivariate analyses to adjust for age, comorbid conditions, and surgical factors. Secondary analyses compared the risks of death and/or stroke in women and men at 2 years after surgery.
Results— The study sample consisted of 6038 patients (35% women). The risks of perioperative stroke or death were not significantly different in women compared with men (adjusted hazard ratio, 1.10; 95% CI, 0.90 to 1.35). The combined risk of stroke or death at 2 years after surgery was also similar in women and men (adjusted hazard ratio, 1.05; 95% CI, 0.92 to 1.21). However, women were more likely to have a stroke (adjusted hazard ratio, 1.26; 95% CI, 1.05 to 1.51) and less likely to die (adjusted hazard ratio, 0.82; 95% CI, 0.68 to 0.99) within 2 years after surgery.
Conclusions— Perioperative complication rates from carotid endarterectomy are similar in women and men. Women should not be discouraged from carotid endarterectomy solely on the basis of surgical risks.
Key Words: carotid endarterectomy • perioperative complications • sex • stroke
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