Institutional peer review can reduce the risk and cost of carotid endarterectomy.
OBJECTIVE
Surgeon-directed institutional peer review, associated with positive physician feedback, can decrease the morbidity and mortality rates associated with carotid endarterectomy.


METHODS
Case series.


METHODS
Tertiary care university teaching hospital.


METHODS
All patients undergoing carotid endarterectomy at our institution during a 5-year period ending August 1998.


RESULTS
Stroke rate decreased from 3.8% (1993-1994) to 0% (1997-1998). The mortality rate decreased from 2.8% (1993-1994) to 0% (1997-1998). Length of stay decreased from 4.7 days (1993-1994) to 2.6 days (1997-1998). The total cost decreased from $13,344 (1993-1994) to $9548 (1997-1998).


CONCLUSIONS
An objective, confidential peer review process that provides ongoing feedback of performance to surgeons and documents that performance in relationship with that of peers seems to be effective in reducing the morbidity and mortality rate associated with carotid endarterectomy. In addition, the review process lowered the hospital cost of performing carotid endarterectomy.
Olcott C
I V
IV
Division of Vascular Surgery, Stanford University Medical Center, Mail Stop H3636, Stanford, CA 94305-5642, USA. olcott@stanford.edu.
Mitchell
R S
RS
Steinberg
G K
GK
Zarins
C K
CK
D000368:Aged; D002140:California / Q000453:epidemiology; D002983:Clinical Competence; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D005246:Feedback; D005500:Follow-Up Studies; D013502:General Surgery; D017048:Health Care Costs; D017721:Hospital Costs; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D007902:Length of Stay / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000517:prevention & control; D018024:Peer Review, Health Care; D011785:Quality Assurance, Health Care; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D015996:Survival Rate