April 22, 1998JAMA
Variation in Carotid Endarterectomy Mortality in the Medicare Population
Key result
Perioperative mortality following carotid endarterectomy in Medicare patients was 1.4% at trial hospitals and 1.7% to 2.5% at nontrial hospitals, substantially higher than reported in clinical trials.
Why the study?
Does hospital trial participation and procedural volume affect perioperative mortality in Medicare patients undergoing carotid endarterectomy?
Population
113,300 Medicare patients undergoing carotid endarterectomy during 1992 and 1993 in all nonfederal…
Comparison
Carotid endarterectomy performed at 'trial… vs Carotid endarterectomy performed at 'nontrial…
Design
Cohort
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
May warrant volume-based referral caution for carotid endarterectomy; leaves open independent effects of trial participation.
Study Design
Type
Cohort (n=113,300)
Multicenter
Yes
Structured PICO
Does hospital trial participation and procedural volume affect perioperative mortality in Medicare patients undergoing carotid endarterectomy?
P
Population
113,300 Medicare patients undergoing carotid endarterectomy (CEA) during 1992 and 1993 in all nonfederal institutional settings.
I
Intervention
Carotid endarterectomy performed at 'trial hospitals' (institutions participating in NASCET and ACAS, n=86).
C
Comparator
Carotid endarterectomy performed at 'nontrial hospitals' (all other nonfederal institutions, n=2613), stratified into terciles based on volume.
O
Outcome
Crude and adjusted perioperative (30 day) mortality rates.hard clinical
Main Result
Effect estimate: mortality risk reduction 15% vs high-volume nontrial hospitals (95% CI 0%-31%)
p-value: p=<.001
Real-world perioperative mortality following carotid endarterectomy in Medicare patients is substantially higher than reported in clinical trials, and is inversely related to hospital procedural volume.
Cite This Study
Wennberg et al. (1998) conducted a cohort in Carotid endarterectomy (n=113,300). Carotid endarterectomy at trial hospitals vs. Carotid endarterectomy at nontrial hospitals was evaluated on Perioperative (30 day) mortality (mortality risk reduction 15% vs high-volume nontrial hospitals, 95% CI 0%-31%, p=<.001). Perioperative mortality following carotid endarterectomy in Medicare patients was 1.4% at trial hospitals and 1.7% to 2.5% at nontrial hospitals, substantially higher than reported in clinical trials.