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Objective: Prior studies have suggested a relationship between operative time and outcome after major vascular procedures. This study analyzed factors associated with operative time and outcome after carotid endarterectomy (CEA) in the national Vascular Quality Initiative (VQI) registry.Methods: Elective, primary CEAs without high anatomic risk or concomitant procedures from 2012 to 2015 in the VQI were analyzed (N ¼ 26,327, performed by 1188 surgeons from 249 centers). Multivariable analysis was used to identify factors associated with operative time and major adverse events, categorized as either technical (ipsilateral stroke, cranial nerve injury, surgical site infection, reoperation) or cardiac (myocardial infarction, congestive heart failure, dysrhythmia).Results: Median CEA operative time was 109 minutes (interquartile range, 85-136). Factors that increased operative time by at least 5 minutes are shown in Table I. Increasing operative time was associated with increased rates of major adverse events (Table II). Increased cardiac complications were independently associated with increased operative time but not with annual surgeon volume. Increased technical complications were associated with increased operative time, but this effect was mitigated by higher annual surgeon volume.Conclusions: Operative time for elective, primary CEAs varies substantially across the VQI. Operative time is associated with surgeon annual volume in addition to expected procedural factors. Longer operative time increases the risk of cardiac complications and is associated with increased technical complications. In addition to proper patient selection and technical proficiency, attention to operative time is important for improving outcomes after CEA.

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