Activities of daily living is a critical factor in predicting outcome after carotid endarterectomy in asymptomatic patients.
OBJECTIVE
Ability to perform basic daily activity represented by functional status (FNS) before surgery can be assessed in the clinic for determining health status of the patient. We sought to study the effect of FNS on postoperative outcomes after carotid endarterectomy (CEA) in a national data set.


METHODS
National Surgical Quality Improvement Project is a national data set, which includes data from >300 hospitals. Patients who underwent CEA were identified by Current Procedural Terminology code and divided into 3 categories based on FNS: independent, partially dependent, and dependent. Thirty-day postoperative stroke, death, and other postoperative complications were identified as the study end point. We used multivariate logistic regression to estimate odds ratio for outcomes while controlling for sex, race, diabetes mellitus, cardiovascular disease, smoking, and other confounders.


RESULTS
Of 19 748 CEAs, 19 348 (97.97%) were functionally independent, 377 (1.99%) were functionally partially dependent, and 23 (0.12%) were functionallydependent. In functionally independent group, there were 196 (1.01%) strokes, 84 (0.43%) deaths, and 1416 (7.17%) other complications, whereas in the functionally partially dependent group, there were 14 (3.71%) strokes, 10 (2.65%) deaths, and 80 (21.22%) other complications. In multivariable risk-adjusted model, using functionally independent as reference, functionally partially dependent was associated with death (odds ratio, 3.3; 95% confidence interval, 1.6-6.8; P<0.001), stroke (odds ratio, 3; 95% confidence interval, 1.7-5.4; P<0.001), and other complications (odds ratio, 2.5; 95% confidence interval, 1.9-3.2; P<0.001).


CONCLUSIONS
In this national data set, patient's inability to perform basic activities of independent living is associated with adverse postoperative outcomes after CEA. Hence, FNS should be vigilantly assessed in clinic for risk stratification along with other objective factors for gauging risk of adverse outcomes after CEA.
From the Departments of Surgery (A.D., B.B., R.L., J.G.R.) and Epidemiology (P.P.), Emory University, Atlanta, GA. adayama@emory.edu.
Anand
A
Dayama
From the Departments of Surgery (A.D., B.B., R.L., J.G.R.) and Epidemiology (P.P.), Emory University, Atlanta, GA.
Pratik
P
Pimple
From the Departments of Surgery (A.D., B.B., R.L., J.G.R.) and Epidemiology (P.P.), Emory University, Atlanta, GA.
Barath
B
Badrinathan
From the Departments of Surgery (A.D., B.B., R.L., J.G.R.) and Epidemiology (P.P.), Emory University, Atlanta, GA.
Richard
R
Lee
From the Departments of Surgery (A.D., B.B., R.L., J.G.R.) and Epidemiology (P.P.), Emory University, Atlanta, GA.
James G
JG
Reeves
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000503:physiopathology
carotid; endarterectomy; outcome assessment