OUTCOME ANALYSIS OF CAROTID ENDARTERECTOMY IN CONNECTICUT - THE IMPACT OF VOLUME AND SPECIALTY

The purpose of this study was to define the relationship between the s urgeon's operative experience and specialty and the postoperative morb idity and mortality of carotid endarterectomy. All patients undergoing carotid endarterectomy (code ICD-9CM 38.12) in Connecticut between Oc tober 1985 and September 1991 were retrospectively identified. A total of 3997 carotid endarterectomies were performed by 226 surgeons in fo ur specialties: general, cardiac, vascular, and neurosurgery. Individu al surgeon volume ranged from fewer than one per year to 27.5 per year (mean 2.9 carotid endarterectomies per year). Outcome was measured as a combined stroke and/or death percentage. The average combined strok e and/or death rate for the entire group was 4.9%. The combined stroke and/or death percentage was influenced significantly by the surgeon's annual volume. Surgeons who performed one or fewer carotid endarterec tomies (43% of total surgeons) were 2.5 times more likely (p < 0.002) to have a poor postoperative outcome than those wile performed 10 or m ore per year (9.3% of total surgeons). Overall there was a statistical ly significant correlation between a surgeon's annual volume and outco me, particularly for general surgeons.