Key result
Carotid artery stenting linked to ~20% higher 30-day readmission risk versus carotid endarterectomy.
Why the study?
Rates and predictors of readmission after carotid endarterectomy compared to carotid artery stenting in the Medicare population were not well characterized.
Does carotid artery stenting reduce readmission rates compared to carotid endarterectomy in the US Medicare population?
Cohort (n=235,247)
Yes
Does carotid artery stenting reduce readmission rates compared to carotid endarterectomy in the US Medicare population?
In the US Medicare population, carotid artery stenting is associated with higher 30-, 60-, and 90-day readmission rates compared to carotid endarterectomy, even after adjusting for comorbidities.
Answers are grounded in this paper and cite their sources.
CAS was associated with higher readmission than CEA in Medicare patients; leaves open strategies to reduce post-carotid readmissions.
OBJECTIVE: We evaluated rates and identified predictors of readmission in the Medicare population after carotid endarterectomy (CEA) compared to carotid artery stenting (CAS). METHODS: MedPAR data (2005-2009) were used to select patients who underwent CEA or CAS (utilizing International Classification of Diseases, Ninth Revision, Clinical Modification codes). Readmission was evaluated using chi-square and multivariable logistic regression. RESULTS: A total of 235 247 carotid interventions were performed (211 118 CEA and 24 129 CAS). Readmission rates (%) for patients undergoing CEA and CAS, respectively, were 8.84 and 11.11 (30 days; P < .0001); 13.31 and 17.98 (60 days; P < .0001); and 16.86 and 22.68 (90 days; P < .0001). Patients aged >80 (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.20-1.30) and patients with renal failure (OR = 1.6 95%; CI = 1.56-1.73), congestive heart failure (OR = 1.6; 95%CI = 1.57-1.73), diabetes (OR = 1.4; 95% CI 1.27-1.52), and CAS (OR = 1.2; 95%CI = 1.15-1.25) were more likely to be readmitted. CONCLUSIONS: Interventions for carotid artery disease had high overall readmission rates. After adjustment for comorbidities, utilization of less invasive techniques (CAS) did not result in lower readmission rates. Further evaluation is needed to determine strategies to reduce hospital readmission rates after carotid interventions.
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Galiñanes et al. (2014) conducted a cohort in Carotid artery disease (n=235,247). Carotid artery stenting vs. Carotid endarterectomy was evaluated on 30-day readmission (OR 1.2, 95% CI 1.15-1.25, p=<.0001). Carotid artery stenting was associated with a higher likelihood of readmission compared to carotid endarterectomy (adjusted OR 1.2; 95% CI 1.15-1.25), with 30-day rates of 11.11% vs 8.84%.
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