title: Staged versus synchronous carotid endarterectomy and coronary artery bypass grafting: analysis of 10-year nationwide outcomes.
abstract: BACKGROUND
  The timing of operative interventions for patients with concurrent carotid and coronary artery disease is controversial. We evaluated nationwide data regarding staged or synchronous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) and compared the two approaches' outcome profiles.
  
  
  METHODS
  From Nationwide Inpatient Sample database 1998 to 2007, we identified 6,153 (28.9%) patients who underwent CEA before or after CABG during the same hospital admission but not on the same day (STAGED) and 16,639 patients who underwent both procedures on the same day (SYNC). Hierarchic multivariable regression was used to assess the independent effect of operative strategy on mortality, neurologic and overall complications, and charges.
  
  
  RESULTS
  Mean age (69.5±9.0 years) and Charlson-Deyo score (4.6±1.5) were similar for both groups. Mortality (4.2% vs 4.5%) or neurologic complications (3.5% vs 3.9%) were similar between the STAGED and SYNC groups (p>0.7 for both). The STAGED patients had higher morbidity (48.4% vs 42.6%; odds ratio [OR] 1.8; 95% confidence interval [CI], 1.5 to 2.2; p<0.001) and more cardiac (OR, 1.5; 95% CI, 1.4 to 1.7; p<0.001), wound (OR, 2.1; 95% CI, 1.8 to 2.4; p<0.001), respiratory (OR, 1.2; 95% CI, 1.1 to 1.3; p=0.001), and renal complications (OR, 1.2; 95% CI, 1.03 to 1.3; p<0.001). In SYNC patients, on-pump CABG increased stroke rates (OR, 1.6; 95% CI, 1.3 to 1.9; p<0.001). The STAGED procedures were independently associated with higher hospital charges by $23,328 (p<0.001).
  
  
  CONCLUSIONS
  We identified no significant difference in mortality or neurologic complications between STAGED and SYNC approaches. Staged procedures were associated with a greater risk of overall complications and higher hospital charges than SYNC. On-pump CABG was associated with higher stroke rates in SYNC patients.
authors: Division of Cardiothoracic Surgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri 65212, USA. gopaldasr@health.missouri.edu
authors: Raja R
authors: RR
authors: Gopaldas
authors: Danny
authors: D
authors: Chu
authors: Tam K
authors: TK
authors: Dao
authors: Joseph
authors: J
authors: Huh
authors: Scott A
authors: SA
authors: LeMaire
authors: Peter
authors: P
authors: Lin
authors: Joseph S
authors: JS
authors: Coselli
authors: Faisal G
authors: FG
authors: Bakaeen
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000401:mortality; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D016208:Databases, Factual; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States