Surgical specialty and outcomes for carotid endarterectomy: evidence from the National Surgical Quality Improvement Program.
BACKGROUND
Carotid endarterectomy (CEA) has been performed since the 1950s and remains one of the most common surgical procedures in the United States. The procedure is performed by cardiothoracic, general, neurologic, and vascular surgeons. This study uses data from the National Surgical Quality Improvement Program (NSQIP) to examine the outcomes after CEA when performed by general or vascular surgeons.


METHODS
Data included 34,493 CEAs from years 2005 to 2010 recorded in the NSQIP database. Primary outcomes measured were length of stay, 30-d mortality, surgical site infection, cerebrovascular accident, myocardial infarction, and blood transfusion requirement. Secondary outcomes measured were the remaining intraoperative outcomes from the NSQIP database.


RESULTS
After controlling for patient and surgical characteristics, patients treated by general surgeons did not have a significantly different LOS or 30-d mortality than those treated by vascular surgeons. Patients of general surgeons had nearly twice the risk of acquiring a surgical site infection (odds ratio [OR] = 1.94; P = 0.012), >1.5 times the risk of cerebrovascular accident (OR = 1.56; P = 0.008), and >1.8 times the risk of blood transfusion (OR = 1.85; P = 0.017) than those of vascular surgeons. Patients of general surgeons had less than half the risk of having a myocardial infarction (OR = 0.34; P = 0.031) than those of vascular surgeons.


CONCLUSIONS
Surgical specialty is associated with a wide range of postoperative outcomes after CEA. Additional research is needed to explore practice and cultural differences across surgical specialty that may lead to outcome differences.
Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Electronic address: lenomoto@hmc.psu.edu.
Laura M
LM
Enomoto
Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Darren C
DC
Hill
Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Peter W
PW
Dillon
Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
David C
DC
Han
Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
Christopher S
CS
Hollenbeak
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data*; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Carotid endarterectomy; Outcomes; Surgeon specialty