title: Race as a predictor of morbidity, mortality, and neurologic events after carotid endarterectomy.
abstract: OBJECTIVE
  Racial disparities in the outcomes of patients undergoing carotid endarterectomy (CEA) have been reported. We sought to examine the contemporary relationship between race and outcomes and to report postdischarge events after CEA.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were reviewed to identify all CEAs performed from 2005 to 2010 by vascular surgeons. The influence of race on outcomes was examined. Multivariate analysis was performed using variables found to be significant on bivariate analysis. The primary outcomes were stroke and mortality. Secondary outcomes were other 30-day complications, including postdischarge events.
  
  
  RESULTS
  CEA was performed on 29,114 white patients (95.7%) and on 1316 black patients (4.3%); the overall stroke and mortality rates were 1.65% and 0.7%, respectively. The stroke rate was 1.6% for whites and 2.5% blacks (P = .009). The 30-day mortality rate was 0.7% for whites and 1.4% for blacks (P = .002). There was a longer operating time (P < .001) and total length of stay (P < .001), more postoperative pneumonias (P = .049), unplanned intubations (P < .001), ventilator dependence (P < .001), cardiac arrests (P < .001), bleeding requiring transfusions (P = .024), and reoperations within 30 days (P = .021) among black patients. Multivariate logistic regression modeling identified black race as an independent risk factor for 30-day mortality (odds ratio, 1.9; P = .007). Black patients also had a greater proportion of in-hospital deaths than white patients (73.7% vs 43.1%; P = .01). There was no between-group difference in the rate of postdischarge strokes. Thirty-six percent of all strokes occurred after discharge at a mean of 8.3 days, and 54.3% of deaths occurred after discharge at a mean of 11 days.
  
  
  CONCLUSIONS
  Black race is an independent risk factor for 30-day mortality after CEA. A significant proportion of strokes and deaths occur after discharge in both racial groups evaluated.
authors: Department of Surgery, Yale University School of Medicine, New Haven, Conn 06510, USA.
authors: Hilary A
authors: HA
authors: Brown
authors: Michael C
authors: MC
authors: Sullivan
authors: Richard G
authors: RG
authors: Gusberg
authors: Alan
authors: A
authors: Dardik
authors: Julie Ann
authors: JA
authors: Sosa
authors: Jeffrey E
authors: JE
authors: Indes
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002340:Carotid Artery Diseases / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D054624:Health Status Disparities; D006323:Heart Arrest / Q000208:ethnology / Q000401:mortality; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D011014:Pneumonia / Q000208:ethnology / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D012121:Respiration, Artificial; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology* / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People