TY - JOUR
T1 - Predictors of perioperative outcomes after carotid revascularization
AU - Nejim, Besma
AU - Obeid, Tammam
AU - Arhuidese, Isibor
AU - Hicks, Caitlin
AU - Wang, Sophie
AU - Canner, Joseph
AU - Malas, Mahmoud
N1 - Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background The aim of our study was to compare and identify possible predictors of perioperative outcomes of carotid endarterectomy (CEA) with carotid artery stenting (CAS) using the procedure-targeted American College of Surgeons National Surgical Quality Improvement Program database. Methods Patients who underwent CEA or CAS were identified in American College of Surgeons National Surgical Quality Improvement Program (2011-2013). Univariate and multivariable logistic regression analyses were performed to evaluate the predictors of perioperative outcomes (any stroke or death, myocardial infarction [MI], 30-d readmission and reoperation). Final models were constructed based on the lowest Akaike Information Criterion. Results A total of 10,169 patients underwent carotid revascularization (CEA: 9817 [96.5%] versus CAS: 352 [3.5%]). Most patients were male (61%). Patients who had CAS were younger (mean age [±standard deviation]: 69.1 [±9.7] versus 71.3 [±9.4] y, P < 0.001); however, they showed a greater prevalence of diabetes (38.4% versus 29.2%), congestive heart failure (4.8% versus 1.4%), and chronic obstructive pulmonary disease (17.3% versus 10.2%) (all P < 0.001). The risk of postoperative stroke and/or death was nearly doubled with CAS (adjusted Odds Ratio = 1.84; 95% confidence interval: 1.07-3.18, P = 0.028). The odds of reoperation were higher in nonwhite patients compared with white patients (adjusted Odds Ratio: 1.34, 95% confidence interval: 0.97-1.84, P = 0.078). Perioperative MI and readmission were mostly related to patient's age and comorbidities. Conclusions In a national data set representing real-world outcome, CAS is associated with higher odds of postoperative mortality and stroke in comparison to CEA. Carotid revascularization procedure type is not a predictor of postoperative MI or readmission, suggesting that these outcomes are a function of other patient factors. Nonwhite race is a predictor of reoperation.
AB - Background The aim of our study was to compare and identify possible predictors of perioperative outcomes of carotid endarterectomy (CEA) with carotid artery stenting (CAS) using the procedure-targeted American College of Surgeons National Surgical Quality Improvement Program database. Methods Patients who underwent CEA or CAS were identified in American College of Surgeons National Surgical Quality Improvement Program (2011-2013). Univariate and multivariable logistic regression analyses were performed to evaluate the predictors of perioperative outcomes (any stroke or death, myocardial infarction [MI], 30-d readmission and reoperation). Final models were constructed based on the lowest Akaike Information Criterion. Results A total of 10,169 patients underwent carotid revascularization (CEA: 9817 [96.5%] versus CAS: 352 [3.5%]). Most patients were male (61%). Patients who had CAS were younger (mean age [±standard deviation]: 69.1 [±9.7] versus 71.3 [±9.4] y, P < 0.001); however, they showed a greater prevalence of diabetes (38.4% versus 29.2%), congestive heart failure (4.8% versus 1.4%), and chronic obstructive pulmonary disease (17.3% versus 10.2%) (all P < 0.001). The risk of postoperative stroke and/or death was nearly doubled with CAS (adjusted Odds Ratio = 1.84; 95% confidence interval: 1.07-3.18, P = 0.028). The odds of reoperation were higher in nonwhite patients compared with white patients (adjusted Odds Ratio: 1.34, 95% confidence interval: 0.97-1.84, P = 0.078). Perioperative MI and readmission were mostly related to patient's age and comorbidities. Conclusions In a national data set representing real-world outcome, CAS is associated with higher odds of postoperative mortality and stroke in comparison to CEA. Carotid revascularization procedure type is not a predictor of postoperative MI or readmission, suggesting that these outcomes are a function of other patient factors. Nonwhite race is a predictor of reoperation.
KW - Carotid endarterectomy
KW - Carotid stenting
KW - Mortality
KW - NSQIP
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=84973558784&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84973558784&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2016.04.074
DO - 10.1016/j.jss.2016.04.074
M3 - Article
C2 - 27565060
AN - SCOPUS:84973558784
SN - 0022-4804
VL - 204
SP - 267
EP - 273
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 2
ER -