Comparison of carotid endarterectomy at high- and low-volume hospitals.
BACKGROUND
Population-based studies have demonstrated better outcomes for carotid endarterectomies at high-volume hospitals.


METHODS
This is a 2-year retrospective review of carotid procedures at two low-volume hospitals (n = 156) and one high-volume hospital (n = 404) in the metropolitan area of Portland, Oregon.


RESULTS
There were no significant differences in 30-day mortality and stroke rates for carotid endarterectomies when comparing low- and high-volume hospitals (P = 0.59). These were comparable rates despite the fact that the low-volume hospitals had significantly older patients (P <0.001), more smokers (P <0.001), more patients with an indication of a previous nondisabling stroke (P <0.01), and fewer patients who were asymptomatic (P <0.01).


CONCLUSIONS
The regionalization of carotid endarterectomy into high-volume hospitals is not justified by the findings of this study. Carotid endarterectomy performed by well-trained, experienced surgeons in low-volume hospitals is a safe procedure.
Peck
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Foundation for Accountability, Oregon Health Science University, 9155 SW Barnes Rd, Suite 304, Portland, OR 97225, USA.
Peck
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Peck
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D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000592:standards*; D005260:Female; D006742:Hospital Bed Capacity; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011361:Professional Competence; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking; D020521:Stroke / Q000209:etiology