Key result
Preoperative partially dependent functional status was associated with significantly higher odds of 30-day death (OR 3.3; 95% CI 1.6-6.8; P<0.001) and stroke after carotid endarterectomy.
Why the study?
Does functional dependence increase the risk of 30-day postoperative stroke, death, and complications in asymptomatic patients undergoing carotid endarterectomy?
Cohort (n=19,748)
Yes
Does functional dependence increase the risk of 30-day postoperative stroke, death, and complications in asymptomatic patients undergoing carotid endarterectomy?
Odds Ratio: 3.3 (95% CI 1.6–6.8)
Absolute Event Rate: 2.65% vs 0.43%
p-value: p=<0.001
In asymptomatic patients undergoing carotid endarterectomy, partial or complete functional dependence is strongly associated with increased 30-day postoperative mortality, stroke, and other complications.
Functional dependence signals higher perioperative risk after asymptomatic CEA; hypothesis-generating and should not yet change practice.
BACKGROUND AND PURPOSE: Ability to perform basic daily activity represented by functional status (FNS) before surgery can be assessed in the clinic for determining health status of the patient. We sought to study the effect of FNS on postoperative outcomes after carotid endarterectomy (CEA) in a national data set. METHODS: National Surgical Quality Improvement Project is a national data set, which includes data from >300 hospitals. Patients who underwent CEA were identified by Current Procedural Terminology code and divided into 3 categories based on FNS: independent, partially dependent, and dependent. Thirty-day postoperative stroke, death, and other postoperative complications were identified as the study end point. We used multivariate logistic regression to estimate odds ratio for outcomes while controlling for sex, race, diabetes mellitus, cardiovascular disease, smoking, and other confounders. RESULTS: Of 19 748 CEAs, 19 348 (97.97%) were functionally independent, 377 (1.99%) were functionally partially dependent, and 23 (0.12%) were functionallydependent. In functionally independent group, there were 196 (1.01%) strokes, 84 (0.43%) deaths, and 1416 (7.17%) other complications, whereas in the functionally partially dependent group, there were 14 (3.71%) strokes, 10 (2.65%) deaths, and 80 (21.22%) other complications. In multivariable risk-adjusted model, using functionally independent as reference, functionally partially dependent was associated with death (odds ratio, 3.3; 95% confidence interval, 1.6-6.8; P<0.001), stroke (odds ratio, 3; 95% confidence interval, 1.7-5.4; P<0.001), and other complications (odds ratio, 2.5; 95% confidence interval, 1.9-3.2; P<0.001). CONCLUSIONS: In this national data set, patient's inability to perform basic activities of independent living is associated with adverse postoperative outcomes after CEA. Hence, FNS should be vigilantly assessed in clinic for risk stratification along with other objective factors for gauging risk of adverse outcomes after CEA.
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Dayama et al. (2014) conducted a cohort in Asymptomatic patients undergoing carotid endarterectomy (n=19,748). Partially dependent functional status vs. Functionally independent status was evaluated on 30-day postoperative death (OR 3.3, 95% CI 1.6-6.8, p=<0.001). Preoperative partially dependent functional status was associated with significantly higher odds of 30-day death (OR 3.3; 95% CI 1.6-6.8; P<0.001) and stroke after carotid endarterectomy.
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