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.
Keywords: Carotid endarterectomy; Carotid stenting; Mortality; NSQIP; Stroke.
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