Risk factors for death or stroke after carotid endarterectomy: observations from the Ontario Carotid Endarterectomy Registry.
OBJECTIVE
Carotid endarterectomy is an effective method for preventing strokes if patients do not suffer adverse perioperative outcomes. The purpose of this study was to identify preoperative patient risk factors for adverse outcomes (death or nonfatal stroke) after carotid endarterectomy through the use of a large population-based registry from Ontario, Canada.


METHODS
Medical records of all 6038 patients who underwent carotid endarterectomy in Ontario between January 1, 1994, and December 31, 1997, were abstracted from 34 hospitals. Patient characteristics (demographic data, past medical history, neurological symptoms, comorbidities, radiological findings) and 30-day postoperative death or stroke rates were analyzed with logistic regression analysis.


RESULTS
The overall 30-day death or stroke rate after surgery was 6.0%. A history of transient ischemic attack or stroke (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.39 to 2.20), atrial fibrillation (OR, 1.89; 95% CI, 1.29 to 2.76), contralateral carotid occlusion (OR, 1.72; 95% C.I., 1.25 to 2.38), congestive heart failure (OR, 1.80; 95% CI, 1.15 to 2.81), and diabetes (OR, 1.28; 95% CI, 1.01 to 1.63) were significant independent predictors for 30-day death or stroke. These 5 factors were combined into a simple risk score that can be used to stratify patients into different risk groups for complications after surgery.


CONCLUSIONS
Several patient characteristics predict the development of stroke and death after carotid endarterectomy. These characteristics may help clinicians in patient counseling and contribute to studies "benchmarking" the outcomes of carotid surgery in the community setting.
Tu
Jack V
JV
Institute for Clinical Evaluative Sciences, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. tu@ices.on.ca
Wang
Hua
H
Bowyer
Beverley
B
Green
Lawrence
L
Fang
Jiming
J
Kucey
Daryl
D
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D015996:Survival Rate