(AS2) Carotid Endarterectomy Patients Treated at Low Volume Centers Are Associated with Higher Likelihood of Major Complications and Nonroutine Discharge
Medical Student Keck School of Medicine, University of Southern California San Marino, California, United States
Disclosure(s):
Kristie Q. Liu, MS: No financial relationships to disclose
Introduction: Stroke is the 5th leading cause of death in the United States. Carotid artery stenosis has an associated stroke risk of 2-5% per year. While optimal medical management can reduce this risk, surgical revascularization with carotid endartectomy (CEA) has been shown to further reduce this stroke risk. Prior studies have shown that high volume medical centers are associated with better outcomes in CEA patients, including decreased mortality. However, in this study, we investigated the bottom 10% of hospitals with regard to procedure volume and evaluated impact on patient outcomes.
Methods: The National Readmissions Database (NRD) was analyzed retrospectively from 2010-2018 to investigate the relationship between hospital procedural volume and patient outcomes in asymptomatic and symptomatic CEA patients, reported as national estimates. Evaluation of independent associations with 30-day readmissions, 90-day readmissions, index mortality, discharge disposition, major complications, and neurological complications was conducted with univariate and multivariate analyses of patient and hospital characteristics.
Results: Analysis of the NRD identified 309,141 total asymptomatic and 32,911 total symptomatic carotid artery stenosis patients who underwent CEA between 2010-2018. 2,693 (0.9%) asymptomatic patients and 428 (1.3%) symptomatic patients were treated at the bottom 10% of medical centers in terms of procedure volume, defined as centers performing < 2 procedures per year. Asymptomatic CEA patients treated at low volume centers were at higher risk of major complications (OR 1.7, CI 1.38-2.08, p< 0.0001) and nonroutine discharge (OR 1.670, CI 1.47-1.89, p< 0.0001). Similarly, symptomatic CEA patients treated at low volume centers were also more likely to experience major complications (OR 1.58, CI 1.16-2.16, p=0.0035) and nonroutine discharge (OR 1.57, CI 1.23-2.01, p=0.0003).
Conclusion : CEA patients, asymptomatic or symptomatic, are at higher risk for major complications and nonroutine discharge at low volume medical centers and may benefit from treatment at higher volume centers.
