INFLUENCE OF AGE AND HOSPITAL VOLUME ON THE RESULTS OF CAROTID ENDARTERECTOMY - A STATEWIDE ANALYSIS OF 9918 CASES

Purpose: This study evaluated the impact of patient age and hospital v olume on the results of carotid endarterectomy (CEA) in contemporary p ractice. Methods: The Maryland Health Services Cost Review Commission (MHSCRC) database was reviewed to identify all patients who underwent elective CEA as the primary procedure in all acute care hospitals in t he state over the past 6 years. Results: From January 1990 through Dec ember 1995, 9918 elective CEAs were performed in 48 hospitals at a tot al charge of $68.9 million. Postoperative death and neurologic complic ations occurred in 90 (0.9%) and 166 (1.7%) cases, including 0.8% and 1.7%, 0.9% and 1.6%, 0.9% and 1.8%, and 1.4% and 1.3% of patients <65 years, 65 to 69 years, 70 to 79 years, and greater than or equal to 80 years old, respectively. The mean length of stay and hospital charges increased linearly with increasing age: 4.2 days/$6550, 4.4 days/$683 4, 4.8 days/$7059, and 5.6 days (p < 0.0001 vs others)/$7756 (p < 0.00 5 vs 70 to 79 years and p < 0.0003 vs <70 years old), respectively, fo r patients <65, 65 to 69, 70 to 79, and greater than or equal to 80 ye ars old. The mortality rate was 1.9% in low-volume hospitals, 1.1% in moderate-volume hospitals, and 0.8% in high-volume hospitals. The neur ologic complication rate was significantly higher (6.1%; p < 0.0001) i n low-volume when compared with moderate-volume (1.3%) and high-volume (1.8%) hospitals. Conclusions: CEA is a safe procedure in the majorit y of hospitals in contemporary practice, even among the very elderly, who may experience a longer length of stay and higher charges correlat ing with their documented greater medical complexity. (J Vasc Surg 199 8;27:25-33.).