Main SCVS Site
Annual Meeting Home
Final Program
Past & Future Meetings
 

Back to 2015 Annual Symposium Program


Impact of Surgical Specialty and Operator Experience upon Outcomes Following Carotid Endarterectomy
Kevin Caldwell, MD, Sarah Koch, MD, Imran Khan, MD, James Pan, MD, Douglas Hood, MD, Kim J. Hodgson, MD, Sapan S. Desai, MD, PhD, MBA.
Southern Illinois University, Springfield, IL, USA.

Objectives: Carotid endarterectomy (CEA) is commonly performed by general surgeons, cardiothoracic surgeons, neurosurgeons, and vascular surgeons, with each specialty having differences in residency structure, operative experience, and subspecialty training. The aim of this study is to evaluate the impact of surgeon specialty on outcomes following elective CEA.
Methods: Patients who underwent elective CEA were identified from the 2007-2009 Nationwide Inpatient Sample (NIS). Physician identifiers in the NIS were used to determine surgical specialty and operative experience. Multivariate analysis adjusted for surgeon experience and mortality risk was used to compare differences in demographics, complications, outcomes, and hospital covariates.
Results: A total of 13,727 patients were identified within the NIS, of which 19.9% underwent CEA by general surgeons, 10.7% by cardiothoracic surgeons, 2.6% by neurosurgeons, and 66.8% by vascular surgeons. The average age, gender, and DRG mortality risk and severity of illness scores were similar between specialties. General surgeons had the highest postoperative risk of bleeding (3.5%, P<0.01) and stroke (1.2%, P<0.05). Cardiothoracic surgeons had the lowest risk of bleeding (1.4%, P<0.001) and cardiac events (0.5%, P<0.01). Neurosurgeons had the highest risk of cardiac events (3.3%, P<0.05) and surgical site infections (0.6%, P<0.01). The length of stay was lowest for vascular surgeons (1.7 +/- 2.4 days, P<0.001), and both cardiothoracic and vascular surgeons had the lowest median cost of hospitalization ($9,151 vs. $9,666 in 2014 USD). Mortality was slightly higher for general surgeons (0.4%) compared to other specialties (0.2-0.3%, P=N.S.). Most general surgeons performing CEA do so at non-teaching hospitals (P<0.001) and tend to work in rural locations (23.5% vs. 5.9% for vascular surgeons, P<0.001). Low volume (<10 cases per year) adversely affects the rate of complications, length of stay and costs (P<0.05) but not mortality.
Discussion: Surgical specialty impacts patient outcome following CEA. General surgeons have a higher rate of complications, longer length of stay, higher costs, and slightly higher mortality; however, they provide more immediate access to care in rural settings. High volume cardiothoracic and vascular surgeons have the fewest complications, shortest length of stay, and the lowest costs. These findings may impact patient referral patterns and hospital privileges for providers.


Back to 2015 Annual Symposium Program
 
© 2024 Society for Clinical Vascular Surgery . All Rights Reserved. Privacy Policy.