title: Hospital-based factors predict outcome after carotid endarterectomy.
abstract: OBJECTIVE
  Patient, hospital, and surgeon factors affect outcome after carotid endarterectomy (CEA). The nature and importance of hospital-specific factors, especially those unrelated to procedural volume, that affect post-CEA outcome remains poorly defined. We used a statewide database to determine the impact of several hospital-associated factors on outcome after CEA.
  
  
  METHODS
  Hospital factors were established by telephone survey and validated by repeated survey as well as by the Connecticut Hospital Association, Connecticut state, and individual hospital internet Websites. All CEA in Connecticut non-federal hospitals between 1991 and 2002 were examined, including perioperative mortality, stroke, and cardiac complications. Multivariable logistic regression was used to analyze data.
  
  
  RESULTS
  There were 14,288 CEAs performed with 0.5% mortality, 1.3% stroke, and 2.4% cardiac complications. The only hospital factor independently predictive of perioperative mortality was few number of hospital beds (less than 132 beds; odds ratio (OR) 2.78, P = 0.032). Factors predictive of perioperative stroke included few number of beds (OR 1.96, P = 0.001) and absence of a critical pathway (OR 1.39, P = 0.038). Factors predictive of perioperative cardiac complications included few number of beds (OR 3.01, P = 0.003), absence of a critical pathway (OR 1.50, P = 0.001), and absence of dedicated vascular recovery beds (OR 1.35, P = 0.03). Combined mortality, stroke, or cardiac complications were independently predicted by few hospital beds (OR 4.58, P = 0.002), absence of a critical pathway (OR 1.81, P < or = 0.0001), or inability to perform cardiac angiography (OR 3.92, P = 0.024).
  
  
  CONCLUSIONS
  Hospital-based factors, such as greater bed capacity, use of critical pathways, ability to perform cardiac angiography, or presence of a dedicated vascular recovery unit predict reduced perioperative mortality, stroke and cardiac complications from CEA. These results suggest that hospital-associated factors do impact surgical outcome and that surgeons need to optimize these factors, extrinsic to the patient and surgeon, to provide maximal quality of care.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06519, USA.
authors.forename: Hilde Hamar
authors.initials: HH
authors.lastname: Westvik
authors.forename: Tormod Schumacher
authors.initials: TS
authors.lastname: Westvik
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Maloney
authors.forename: Fabio A
authors.initials: FA
authors.lastname: Kudo
authors.forename: Akihito
authors.initials: A
authors.lastname: Muto
authors.forename: Jose O M
authors.initials: JO
authors.lastname: Leite
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gusberg
authors.forename: Charles
authors.initials: C
authors.lastname: Cha
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
mesh_terms: D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006742:Hospital Bed Capacity; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020521:Stroke / Q000209:etiology