Intraoperative Completion Studies and their Associations with Carotid Endarterectomy Outcomes

Objective: This study aimed at assessing outcomes after carotid endarterectomy (CEA) in dependence of center policy with respect to imaging intraoperative completion study (ICS i ) usage. Summary Background Data: Although randomized controlled studies are missing, a beneficial effect was shown for ICS i techniques (i.e., angiography and intraoperative duplex ultrasound) after CEA. Methods: This secondary data analysis is based on the German statutory quality assurance database. Research was funded by Germany’s Federal Joint Committee Innovation Fund (G-BA Innovationsfonds, 01VSF19016 ISAR-IQ). According to their ICS i policy, hospitals were categorized as routine ICS i (>90%), selective ICS i (10–90%), or sporadic ICS i (<10%) centers . Primary study outcome was in-hospital stroke or death. Multivariable regression analyses were performed. Results: Between 2012 and 2016, a total of 119,800 patients underwent CEA. In-hospital stroke or death rates were lower in routine ICS i centers (1.7%) compared to selective (2.1%) and sporadic ICS i centers (2.0%). The multivariable regression analysis showed, that in routine ICS i centers , ICS i use was associated with lower rates of stroke or death (aOR 0.64; 95% CI 0.44–0.93). In selective ICS i centers , ICS i was not associated with the occurrence of either of the assessed outcomes. In sporadic ICS i centers , ICS i was associated with higher rates of stroke or death (aOR 1.91; 95% CI 1.26–2.91). Conclusions: Lowest in-hospital stroke or death rates are achieved in r outine ICS i centers . While ICS i is associated with a lower perioperative risk in r outine ICS i centers , it might act as a surrogate marker for worse outcomes due to intraoperative irregularities in sporadic ICS i centers . Routine use of ICS i is advisable.