TITLE

Variations in rates of appropriate and inappropriate carotid endarterectomy for stroke prevention in 4 Canadian provinces

AUTHOR(S)
Kennedy, James; Hude Quan; Ghali, William A.; Feasby, Thomas E.
PUB. DATE
August 2004
SOURCE
CMAJ: Canadian Medical Association Journal;8/31/2004, Vol. 171 Issue 5, p455
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Carotid endarterectomy (CE), when performed on appropriate patients, reduces the incidence of stroke, yet there are marked variations in rates of this procedure. We sought to determine reasons for the variation in CE rates in 4 Canadian provinces. Methods: We identified all CEs performed in 4 Canadian provinces between January 2000 and December 2001, inclusive. From chart review and expert assessment, we deter-mined the proportion of these procedures that were appro-priate, inappropriate or of uncertain appropriateness, using the RAND/UCLA Appropriateness Method. We sought to determine the variation in rates by province and whether the variation was due to differences in type of hospital, surgical specialty or surgical volume. Results: Overall, 1656 (52.3%) of the 3167 CEs studied were performed for appropriate indications. The proportions of appropriate procedures were 78.2% (176/225) in Saskatchewan, 58.7% (481/819) in Alberta, 49.1% (350/713) in Mani-toba and 46.0% (649/1410) in British Columbia ( p < 0.001 across provinces). Rates of appropriate procedures per 100 000 population ranged from 44.3 in Manitoba to 16.2 in Saskatchewan ( p < 0.001 across provinces). CEs were more likely to be appropriate when performed by a neurosurgeon compared with all other surgeons (74.4% v. 49.4% were appropriate; p < 0.001), when performed by surgeons doing fewer than 31 procedures over 2 years compared with surgeons doing more than 31 (70.1% v. 49.5% were appropriate; p < 0.001) and when performed in hospitals doing fewer than 135 procedures per year compared with hospitals doing more than 135 (63.4% v. 49.1% were ap-propriate; p < 0.001). Overall, 10.3% of procedures were done for inappropriate reasons. Interpretation: Our findings suggest some overuse (for inappropriate or uncertain indications) but also some underuse (low population rates in some regions). High rates of CE are associated with lower rates of appropriateness...
ACCESSION #
14167997

 

Related Articles

  • Carotid Surgery Following Previous Carotid Endartectomy Is Safe and Effective. Abou-Zamzam Jr., Ahmed M.; Moneta, Gregory L.; Landry, Gregory J.; Yeager, Ricahrd A.; Edwards, James M.; McConnell, Donald B.; Taylor Jr., Lloyd M.; Porter, John M. // Vascular & Endovascular Surgery;Jul/Aug2002, Vol. 36 Issue 4, p263 

    Presents a review of a prospectively acquired vascular registry over a ten-year period to identify patients undergoing repeat carotid surgery following previous carotid endarterectomy (CEA). Background on the role of CEA in the treatment of extracranial carotid artery stenosis; Medical history...

  • Cartoid Endarterectomy in Octogenarians with Symptomatic High-Grade Internal. Metz, R.; Teijink, J.A.W. // Vascular & Endovascular Surgery;Nov/Dec2002, Vol. 36 Issue 6, p409 

    The objective of this study was to evaluate the clinical and duplex outcome after carotid endarterectomy (CEA) in recently symptomatic patients aged 80 years or older. Information was assembled from a prospective data collection of all CEAs performed from January 1986 to December 1999. Included...

  • Factors Related to Short Length of Stay After Carotid Endarterectomy. Hernandez, Nathalie; Salles-Cunha, Sergio X. // Vascular & Endovascular Surgery;Nov/Dec2002, Vol. 36 Issue 6, p425 

    In the past decade, expected in-hospital length of stay (LOS) after carotid endarterectomy (CEA) has decreased from 4 days to 1. Long LOS is associated with known complications and factors affecting severity of the patient's condition. Factors affecting an intermediate stay of 2 to 4 days need...

  • When to discharge endarterectomy patients. H.D.B. // Cortlandt Forum;03/25/97, Vol. 10 Issue 3, p122 

    Warns physicians of the dangers of the practice of discharging patients on the first day after carotid endarterectomy if they are stable. Concerns over the safety of such practice.

  • Endarterectomy for asymptomatic carotid artery stenosis. Irvine, Craig D.; Baird, Roger N. // BMJ: British Medical Journal (International Edition);10/28/95, Vol. 311 Issue 7013, p1113 

    Editorial. Compares the performance of carotid artery endarterectomy in Great Britain and North America. Major multicenter trials in carotid endarterectomy in North America and Great Britain; Risks associated with carotid endarterectomy; Three ra ndomized studies of surgery for asymptomatic...

  • Risks and benefits of surgery for carotid endarterectomy. WALLING, ANNE D. // American Family Physician;10/15/1998, Vol. 58 Issue 6, p1439 

    Presents the abstract of the article `Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST),' by the European Carotid Surgery Trialists' Collaborative Group from the `Lancet' journal dated May 9, 1998.

  • Clinical angiographic predictors of stroke and death... Rothwell, P.M.; Slattery, J.; Warlow, C. P. // BMJ: British Medical Journal (International Edition);12/13/97, Vol. 315 Issue 7122, p1571 

    Identifies risk factors for operative stroke and death from carotid endarterectomy. Limitations of the benefit derived from carotid endarterectomy; Angiographic characteristic associated with increased risk of operative stroke or death; Factors which increases the risk of people undergoing...

  • Model predicts who benefits from carotid endarterectomy. Kmietowicz, Zosia // BMJ: British Medical Journal (International Edition);06/26/99, Vol. 318 Issue 7200, p1719 

    Offers information on a risk modeling study developed in Great Britain, to identify which patients will benefit most from carotid endarterectomy. Prognostic factors incorporated in the model; Details on the findings of the study; Implications of the findings.

  • Nonendarterectomy Procedures of the Carotid Artery: A Five-Year Review. TAYLOR, SPENCE M.; LANGAN III, EUGENE M.; SNYDER, BRUCE A.; CULL, DAVID L.; CRANE, MARTIN M. // American Surgeon;Apr1999, Vol. 65 Issue 4, p323 

    Focuses on a study on the employment of nonendarectomy procedures of the carotid artery. Information on carotid endarectomy; Materials and patients; Results and discussion.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics