title: Impact of symptoms, gender, co-morbidities, and operator volume on outcome of carotid artery stenting (from the Nationwide Inpatient Sample [2006 to 2010]).
abstract: The increase in the number of carotid artery stenting (CAS) procedures over the last decade has necessitated critical appraisal of procedural outcomes and patterns of utilization including cost analysis. The main objectives of our study were to evaluate the postprocedural mortality and complications after CAS and the patterns of resource utilization in terms of length of stay (LOS) and cost of hospitalization. We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 2006 to 2010 using the International Classification of Diseases, Ninth Revision, procedure code of 00.63 for CAS. Hierarchical mixed-effects models were generated to identify the independent multivariate predictors of in-hospital mortality, procedural complications, LOS, and cost of hospitalization. A total of 13,564 CAS procedures (weighted n = 67,344) were analyzed. The overall postprocedural mortality was low at 0.5%, whereas the complication rate was 8%, both of which remained relatively steady over the time frame of the study. Greater postoperative mortality and complications were noted in symptomatic patients, women, and those with greater burden of baseline co-morbidities. A greater operator volume was associated with a lower rate of postoperative mortality and complications, as well as shorter LOS and lesser hospitalization costs. In conclusion, the postprocedural mortality after CAS has remained low over the recent years. Operator volume is an important predictor of postprocedural outcomes and resource utilization.
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan. Electronic address: apurva.badheka@yale.edu.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: University of Pittsburgh Medical Center, Shadyside Hospital, Pittsburgh, Pennsylvania.
authors.forename: Kathan
authors.initials: K
authors.lastname: Mehta
authors.affiliation: Staten Island University Hospital, Staten Island, New York.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: University of Arkansas, Little Rock, Arkansas.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Peeyush
authors.initials: P
authors.lastname: Grover
authors.affiliation: Staten Island University Hospital, Staten Island, New York.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Shah
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Chirag N
authors.initials: CN
authors.lastname: Savani
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Vinaykumar
authors.initials: V
authors.lastname: Panchal
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Brown
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Amir
authors.initials: A
authors.lastname: Kaki
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kondur
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohamad
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Mahir
authors.initials: M
authors.lastname: Elder
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
authors.affiliation: Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000453:epidemiology* / Q000601:surgery; D015897:Comorbidity / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D020521:Stroke / Q000453:epidemiology*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*