Racial variations in postoperative outcomes of carotid endarterectomy: evidence from the Veterans Affairs National Surgical Quality Improvement Program.
BACKGROUND
Black patients and Hispanic patients receive carotid endarterectomy (CEA) at lower rates than white patients. It is unclear whether worse surgical outcomes are influencing clinical decision-making regarding use of the operation among minority group patients.


OBJECTIVE
To determine if there are racial differences in postoperative outcomes for patients undergoing CEA at Veterans Affairs (VA) medical centers.


METHODS
Secondary analysis of data from an ongoing, prospective study on surgical quality and outcomes in the VA health care system.


METHODS
One hundred thirty-two VA Medical Centers that were part of the VA National Surgical Quality Improvement Program.


METHODS
A cohort of 6551 men (91.4% white, 5.3% black, and 3.3% Hispanic) who had CEA performed between October 1, 1994 and September 30, 1997.


METHODS
Primary outcomes were stroke or death and stroke, myocardial infarction (MI), or death within 30 days of the operation.


RESULTS
Thirty-day postoperative rates of stroke or death and of stroke, MI, or death were generally low for all racial/ethnic groups, ranging between 2.6% and 6.5%. Within clinical states that define indications for CEA, rates were also low (1.6% to 3.2%) among asymptomatic patients across racial/ethnic groups. However, among patients with transient ischemic attack (TIA), Hispanic patients had significantly worse outcomes than white patients with a postoperative rate of stroke or death of 10.5% (P < 0.05) and stroke, MI, or death of 13.2% (P < 0.05) compared with 3.1% to 3.5% for white patients. Hispanic patients did not differ from black patients for stroke, death/stroke, death, or MI.


CONCLUSIONS
Rates of major postoperative complications after CEA are low within the VA and similar across racial/ethnic groups with the possible exception of Hispanic men with TIA. Further investigation of this elevated complication rate among Hispanic men with TIA may be warranted.
Horner
Ronnie D
RD
VA Epidemiologic Research and Information Center, Center for Health Services Research in Primary Care, Stroke QUERI Program, Durham, North Carolina, USA. horne003@mc.duke.edu
Oddone
Eugene Z
EZ
Stechuchak
Karen M
KM
Grambow
Steven C
SC
Gray
John
J
Khuri
Shukri F
SF
Henderson
William G
WG
Daley
Jennifer
J
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000706:statistics & numerical data; D006302:Health Services Research; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000208:ethnology / Q000517:prevention & control; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D044469:Racial Groups; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000145:classification / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*