title: Predictors of perioperative outcomes after carotid revascularization.
abstract: The aim of our study was to compare and identify possible predictors of perioperative outcomes of carotid endarterectomy (CEA) with carotid artery stenting (CAS) using the procedure-targeted American College of Surgeons National Surgical Quality Improvement Program database.
  
  
  
  Patients who underwent CEA or CAS were identified in American College of Surgeons National Surgical Quality Improvement Program (2011-2013). Univariate and multivariable logistic regression analyses were performed to evaluate the predictors of perioperative outcomes (any stroke or death, myocardial infarction [MI], 30-d readmission and reoperation). Final models were constructed based on the lowest Akaike Information Criterion.
  
  
  
  A total of 10,169 patients underwent carotid revascularization (CEA: 9817 [96.5%] versus CAS: 352 [3.5%]). Most patients were male (61%). Patients who had CAS were younger (mean age [±standard deviation]: 69.1 [±9.7] versus 71.3 [±9.4] y, P < 0.001); however, they showed a greater prevalence of diabetes (38.4% versus 29.2%), congestive heart failure (4.8% versus 1.4%), and chronic obstructive pulmonary disease (17.3% versus 10.2%) (all P < 0.001). The risk of postoperative stroke and/or death was nearly doubled with CAS (adjusted Odds Ratio = 1.84; 95% confidence interval: 1.07-3.18, P = 0.028). The odds of reoperation were higher in nonwhite patients compared with white patients (adjusted Odds Ratio: 1.34, 95% confidence interval: 0.97-1.84, P = 0.078). Perioperative MI and readmission were mostly related to patient's age and comorbidities.
  
  
  
  In a national data set representing real-world outcome, CAS is associated with higher odds of postoperative mortality and stroke in comparison to CEA. Carotid revascularization procedure type is not a predictor of postoperative MI or readmission, suggesting that these outcomes are a function of other patient factors. Nonwhite race is a predictor of reoperation.
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Besma
authors: B
authors: Nejim
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Tammam
authors: T
authors: Obeid
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Isibor
authors: I
authors: Arhuidese
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Caitlin
authors: C
authors: Hicks
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Sophie
authors: S
authors: Wang
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Joseph
authors: J
authors: Canner
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland. Electronic address: bmalas1@jhmi.edu.
authors: Mahmoud
authors: M
authors: Malas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology
keywords: Carotid endarterectomy; Carotid stenting; Mortality; NSQIP; Stroke