Index Complications Associated with Increased Mortality Post CEA
Tarik Z. Ali, MD, Erik Lehman, MS, Faisal Aziz, MD, FACS.
Penn State Milton S. Hershey Medical Center, hershey, PA, USA.
Objective:In recent years there has been increased interest in index complications in the surgical patient and its implication over outcomes. These index complications identified pre or post operatively can predict outcomes including 30-day mortality. We sought to examine and identify index complications as predictors of 30-day mortality in patients undergoing a Carotid endarterectomy (CEA).Methods:The 2010 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used: patients undergoing CEA were identified. A bivariate and multivariate analysis was done using logistic regression analysis. Variables pre and post operatively as they related to 30-day mortality were identified. Results:A total of 8,748 patients (60% Males, 40% Females), mean age of 71.1 years, mean BMI of 28.5, 93.7% Caucasian, 4.4%African American, 1.24% Asian, 0.2% Native Hawaiian or Pacific Islander underwent a CEA. The multivariable model showed the following factors to be associated with 30-day mortality:Female gender (OR2.57), Hemiplegia (OR 3.24), history of pneumonia within 30 days of the operation (OR 6.12), Unplanned intubation (OR 3.85), Urinary Tract Infection within 30 days of the operation (OR 3.86), Stroke/CVA within 30 days of the operation (OR 11.37), history of Myocardial infarction within 30 days (OR 5.42). Total 30-day mortality was 0.7%. Conclusion:This study demonstrated that index complications are associated with an increased risk of post-operative 30-day mortality after CEA. Post-operative UTI, Stroke/CVA and MI are all associated with increased risk of death within 30 days of undergoing a CEA. Pre-operatively was also found to be associated with increased risk of death within 30 days of undergoing a CEA.
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