title: Outcomes of carotid endarterectomy: how does the Australian state of New South Wales compare with international benchmarks?
abstract: OBJECTIVE
  The objective of this study was to determine the outcomes of carotid endarterectomy (CEA) in New South Wales, Australia.
  
  
  METHODS
  This state-wide prospective audit of all public and private hospitals during a 6-month period had main outcome measures of 30-day mortality, 30-day fatal stroke, 30-day nonfatal stroke, and 30-day combined stroke and mortality.
  
  
  RESULTS
  Fifty-three of 54 eligible surgeons participated (response rate, 98%). The audit obtained inpatient data for 689 internal CEA procedures performed on 666 patients. Of 666 first or only procedures, 462 (69.4%) were performed on patients who were symptomatic and 204 (30.6%) on patients who were asymptomatic. After adjustment for cluster by surgeon, we determined a state-wide 30-day death rate of 1.2% (95% CI, 0.3% to 2.1%), a 30-day fatal or nonfatal stroke rate of 3.0% (95% CI, 1.6% to 4.4%; ipsilateral stroke, 2.6%), a 30-day nonfatal stroke rate of 2.3% (95% CI, 1.1% to 3.4%; ipsilateral stroke, 2.0%), and a 30-day combined stroke and death rate of 3.5% (95% CI, 2.1% to 4.9%). A significant linear relationship was found between patient preoperative hypertensive status and the combined 30-day stroke and death rate (trend odds ratio, 3.5; 95% CI, 1.6 to 7.7). No association was seen between any main outcome measures and hospital volume (<10 CEAs versus > or = 10 CEAs). Four patients underwent surgery outside guideline recommendations (CEA performed for either < or = 30% stenosis or occluded carotid artery).
  
  
  CONCLUSIONS
  This first comprehensive state-wide audit confirms that Australian surgeons achieve 30-day outcomes comparable with international benchmarks.
authors.affiliation: Needs Assessment & Health Outcomes Unit, Central Sydney Area Health Service, Sydney, New South Wales, Australia.
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
authors.forename: Neil
authors.initials: N
authors.lastname: Donnelly
mesh_terms: D000367:Age Factors; D000368:Aged; D019985:Benchmarking; D002340:Carotid Artery Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery; D017536:Carotid Artery, Common / Q000473:pathology / Q000601:surgery; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008330:Management Audit; D009517:New South Wales / Q000453:epidemiology; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome