title: Carotid endarterectomy national trends over a decade: does sex matter?
abstract: BACKGROUND
  The objective was to evaluate the difference in timing (if any) of in-hospital carotid endarterectomy (CEA) or outcomes of CEA based on sex among men and women hospitalized for carotid artery disease.
  
  
  METHODS
  This was a retrospective cross-sectional study using the Nationwide Inpatient Sample Database. All patients from 2000-2009 who underwent CEA during their hospitalization were examined. International Classification of Diseases, 9th revision codes were used to identify patients who underwent CEA during hospitalization, stratify asymptomatic and symptomatic patients, determine time in days from admission to CEA, and examine in-hospital complications, including perioperative stroke, cardiac events, and death. Statistical analysis was performed with chi-squared and t-tests. Linear and logistic regression models were used to evaluate relationships between sex and outcomes. The main outcome measures were time from admission to surgery, in-hospital mortality, complications, mean duration of stay, and discharge disposition.
  
  
  RESULTS
  Two hundred twenty-one thousand two hundred fifty three patients underwent CEA during hospitalization. More than 9% (9.2%) had symptomatic carotid artery disease. Among symptomatic patients, bivariate analysis found that women had a longer mean time from admission to surgery (2.8 vs. 2.6 days; P < 0.001) and a longer duration of hospital stay (6.4 vs. 5.9 days; P < 0.001) than their male counterparts. However, there was no difference between men and women with regard to rates of perioperative stroke, cardiac complications, myocardial infarction, or death. Among asymptomatic patients, women had a longer mean time from admission to surgery (0.53 vs. 0.48 days; P < 0.001) and a trend toward increased perioperative stroke (0.6% vs. 0.5%; P = 0.06), but a lower rate of cardiac complications (1.5% vs. 1.7%; P = 0.01) and in-hospital mortality (0.26% vs. 0.31%; P = 0.05). However, on multivariable analysis adjusting for differences in age, elective status, insurance, race, hospital location, hospital region, and hospital teaching status, there was no sex disparity in time from admission to surgery, regardless of symptomatic status. In addition, asymptomatic women were less likely than men to have a cardiac complication (odds ratio [OR]: 0.90; 95% confidence interval [CI]: 0.83-0.97) or in-hospital mortality (OR: 0.83; 95% CI: 0.70-0.98). Symptomatic women were also less likely than men to have a cardiac complication (OR: 0.78; 95% CI: 0.63-0.97).
  
  
  CONCLUSIONS
  In this decade-long national population-based study of hospitalized patients undergoing CEA, women had lower perioperative cardiac morbidity and mortality rates than men. After adjusting for patient, clinical, and hospital factors, there is no discernible difference in timing of CEA based on sex.
authors: Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI. Electronic address: sreyram@gmail.com.
authors: Sreyram
authors: S
authors: Kuy
authors: Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI.
authors: Anahita
authors: A
authors: Dua
authors: Department of Surgery, Duke University, Durham, NC.
authors: Sapan S
authors: SS
authors: Desai
authors: Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI.
authors: Peter J
authors: PJ
authors: Rossi
authors: Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI.
authors: Gary R
authors: GR
authors: Seabrook
authors: Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI.
authors: Brian D
authors: BD
authors: Lewis
authors: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors: Bhavin
authors: B
authors: Patel
authors: Department of Surgery, University General Hospital, Houston, TX.
authors: Sreyreath
authors: S
authors: Kuy
authors: Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI.
authors: Cheong J
authors: CJ
authors: Lee
authors: Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI.
authors: Rishi
authors: R
authors: Subbarayan
authors: Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI.
authors: Kellie R
authors: KR
authors: Brown
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology