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Carotid Endarterectomy in Asymptomatic Patients: Using the ACS-NSQIP Database to Shed Light on Gender Differences
Jamal J. Hoballah1 MD, MBA; Anthony G. Haddad2, MD; Elie P. Ramly1,3, MD; Hani Tamim, PhD2
1 Department of Surgery, American University of Beirut Medical Center, Lebanon, 2 Department of Internal Medicine, American University of Beirut Medical Center, Lebanon, 3 Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
Objective
Gender differences in outcomes after CEA in asymptomatic patients remain unresolved. The objective of this study was to compare 30-day postoperative stroke, myocardial infarction and mortality outcomes between asymptomatic male and female patients undergoing carotid endarterectomy (CEA) from a prospective validated outcomes registry.
Methods
Data from The American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was obtained for the time period of 2008 to 2012 using CPT codes for CEA. Patients with a preoperative history of neurologic symptoms were excluded, keeping only asymptomatic patients for analysis. Demographics, preoperative comorbidities and postoperative mortality and morbidity data were retrieved. Multivariate logistic regression models were used to assess the independent effect of gender on stroke, mortality and myocardial infarction (MI), while controlling for the pertinent preoperative and intraoperative risk factors.
Results
Data for 29,818 patients who underwent CEA was obtained, 17,640 (59.1%) of whom were males and 12,178 (40.9 %) were females. 199 (1.1 %) males and 171 (1.4 %) females suffered a postoperative stroke (p=0.034). There were no significant differences in baseline characteristics, both groups were comparable except for females who were more likely to have a higher mean Body Mass Index (BMI) (28.57 ±6.54 as compared to 28.40 ±5.44 in males; p < 0.001). On multivariate analysis, female gender independently predicted higher postoperative rates of stroke [OR = 1.30 (95% CI: 1.06-1.60), p = 0.013] and MI [OR = 1.29 (CI: 1.01-1.64); p= 0.038]. There was no statistically significant increase in postoperative mortality [OR = 1.29 (CI: 0.93-1.77), p = 0.124)
Conclusion
In a retrospective cohort of asymptomatic ACS-NSQIP patients undergoing carotid endarterectomy, female gender was found to be an independent predictor of 30-day postoperative stroke and myocardial infarction, but was not associated with an increased risk of death.
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