title: National trends in utilization and postprocedure outcomes for carotid artery revascularization 2005 to 2007.
abstract: OBJECTIVE
  This study compared, at a national level, trends in utilization, mortality, and stroke after carotid angioplasty and stenting (CAS) and carotid endarterectomy (CEA) from 2005 to 2007.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) was queried for patient discharges with International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes for CAS and CEA. The primary outcomes were in-hospital mortality, stroke, hospital charges, and discharge disposition. Subgroup analyses were performed to evaluate these outcomes by neurologic presentation using χ(2) and multivariable logistic regression.
  
  
  RESULTS
  Of the 404,256 discharges for carotid revascularization, CAS utilization was 66% higher in 2006 than in 2005 (9.3% vs 14%, P = .0004). Crude mortality, stroke, and median charges remained higher for CAS than for CEA; discharge to home was more common after CEA. Results improved from 2005 to 2007. By logistic regression of the total cohort from 2005 to 2006, CAS was independently predictive of mortality (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.08-2.00; P < .0001). Independent predictors of stroke included CAS (OR, 1.43; 95% CI, 1.18-1.73; P < .0001) and symptomatic disease (OR, 2.4; 95% CI, 2.06-2.93;P < .0001). Among subgroups based on neurological presentation, regression showed that CAS significantly increased the odds of stroke in asymptomatic patients (OR, 1.6; 95% CI, 1.2-2.0; P = .0003). Among symptomatic patients, CAS increased the odds of in-hospital death (OR, 3.0; 95% CI, 1.7-5.1, P < .0001) and trended toward significance for stroke (OR, 1.7; 95% CI, 1.0-2.8; P = .0569).
  
  
  CONCLUSIONS
  Utilization of CAS has increased from the years 2005 to 2007 with some improvements in the outcome. Despite improvements in outcome, resource utilization remains significantly higher for CAS than CEA.
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass 01655, USA. EslamiM@ummhc.org
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Eslami
authors.forename: James T
authors.initials: JT
authors.lastname: McPhee
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Simons
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
authors.forename: Louis M
authors.initials: LM
authors.lastname: Messina
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000401:mortality / Q000706:statistics & numerical data*; D002340:Carotid Artery Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D010351:Patient Discharge; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States