Multicenter retrospective review of results and complications of carotid endarterectomy in 1981.

Abstract

A multicenter retrospective audit of carotid endarterectomies performed during 1981 was completed with 46 institutions contributing 3,328 cases. Overall, there was a 2.5% risk of transient neurological dysfunction following surgery and a 6% risk of stroke or death. The intra-institutional combined major morbidity and mortality varied from 21% to 0. Those institutions with greater than 700 beds had a statistically lower incidence of stroke or death than did other institutions. The incidence of stroke or death postoperatively was significantly lower for patients who were operated on for amaurosis fugax or for unspecified reasons. Those patients who were operated on for a progressing stroke had a higher incidence of stroke but this group was at greatest risk for stroke without surgery. The incidence of postoperative stroke or death was related to the type of arterial repair; vein patch grafting was statistically better than both fabric patch grafting and primary closure. When all patients who were not monitored during surgery were compared to all patients who had electroencephalographic (EEG) monitoring, there was found to be a significant statistical difference in favor of the EEG group. Endarterectomy combined with coronary artery bypass or simultaneous bilateral endarterectomies had a statistically significant higher incidence of stroke or death than did unilateral carotid endarterectomy.

Multicenter review of preoperative risk factors for carotid endarterectomy in patients with ipsilateral symptoms.

“…10 -"' 23 - 25 In a study similar to the present work, Fode and coworkers 13 carried out a multicenter retrospective review of the results and complications of endarterectomy performed in 1981 with 46 institutions contributing 3328 cases. There was a 6.2% overall risk of perioperative (occurring during hospitalization) stroke or death, 4.2% risk of nonfatal stroke, and 2.0% risk of death.…”

“…13 -' s In the present study, only adverse events occurring during the hospitalization for carotid endarterectomy were considered. Because the study was retrospective, the definition of perioperative complications as those occurring within 30 days of the surgical procedure was not used.…”

“…For study of Fode et al, 13 qualifying symptoms were presumed to be ipsilateral to the side of carotid endarterectomy. Probabilities were determined by x 2 tests.…”

Declining morbidity and mortality of carotid endarterectomy. The Wake Forest University Medical Center experience.

“…Hertzer et al 12 Duke et al 13 Moore et al 14 Thompson and Talkington 13 White et al 16 Lees and Hertzer 17 Burke et al' 8 Bunt and Haynes 19 Fode et al 20 This study Community hospitals Nunn 3 Easton and Sherman 21 Cornell 22 Kremer and Ahlquist 23 Carmichael 24 Modi et al 23 Tables 4-6 list those reports from which data on complications could be extracted by subgroups of asymptomatic stenosis, TLA, orestab- DeBakey et al 5 Yashon et al 28 Heyman et al 6 Bloodwell et al 29 Young et al 7 Erikson et al 30 Fields et al 31 DeWeese et al 8 Smith et al 32 DeWeese et al 33 Hooshmand et al 34 Ford et al 35 Ojemann et al 10 Kanaly et al" Mungas and Baker 3 * Stanford et al 37 Hertzer et al 12 Toole et al 1 Duke et al 13 Thompson and Talkington 13 Riles et al 38 Owens et al 39 White ct al 16 Carson et al 40 Lees and Hertzer 17 Whisnant et al 41 Bunt Yashon et al 28 Heyman et al 6 Erikson ct al 30 Thompson et al 43 DeWeese e...…”

Perioperative stroke Part I: General surgery, carotid artery disease, and carotid endarterectomy

“…99,103 The surgeons performing carotid endarterectomy should evaluate their own results, il9.12o The upper limits of morbidity and mortality that should prompt individual peer review have been defined by an Ad Hoc Committee on Carotid Surgery Standards of the Stroke Council, American Heart Association.121 The 30-day mortality rate from all causes for all carotid endarterectomies should not exceed 2%. The upper limit of combined morbidity and mortality due to stroke during or after carotid endarterectomy is adjusted according to the indications for surgery.…”