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Variability in Carotid Endarterectomy:An outcome and cost Analysis
Sibu P. Saha, MD,MBA, David Minion, MD, Eleftherios Xenos, MD, Victor Ferraris, MD, PhD, Daniel Davenport, PhD, Eric Endean, MD.
University of KY, Lexington, KY, USA.
Background: Carotid thromboendarterectomy (CTE) is a common surgical procedure. There is a wide variability in the technique of this operation, but there is limited evidence regarding risks and benefits of one method compared to another. We wondered whether outcomes varied depending on the method used for CTE at our institution.
Objective: To investigate the procedural variability of CTE at the UK Medical Center with a focus on hospital outcomes and costs.
Methods: We reviewed the charts of a consecutive series of patients undergoing CTE at our institution from July 2000 to December 2009. We analyzed the variability in shunt use and patch closure across surgeons. We then compared patient risk factors, outcomes, and costs between shunt and no-shunt patients. We obtained the costs from the hospital cost accounting system for cases performed in 2008.
Results: Data on 374 procedures for 349 patients who underwent CTE showed significant technique variation across 10 surgeons in shunt utilization (43% in the group as a whole with range from 3% to 94%, p < .01) and patch utilization (group 40%, surgeons ranged from 0 to 94 %, p < .01). Surgeons use of shunts correlated with patch utilization (r = .78, p < .01) and operative duration increased 84 minutes on average in the shunt group (t-test p < .01). Shunted patients were more symptomatic while prior CTE history was similar in the two groups (Table 1). There were no statistically significant differences in death, stroke, length of stay or costs in the two groups (Table 2). Patients without shunts more frequently required an ICU stay (p < .01).
Table 1. Symptoms and comorbid risks.
* p -values are from fisher’s exact test for binary variables and t-test for age.
Table 2. Perioperative variables and outcomes.
* p -values are from fisher’s exact test for binary variables, median test for length of stay and t-tests for operative duration and costs.
Conclusion: The technique of CTE varies widely among surgeons at a single institution without significant difference in cost or outcomes.
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