A regional collaborative audit of the practice and outcome of carotid endarterectomy in the United Kingdom

Objectives: to evaluate performance and outcome of carotid endarterectomy ( CEA) against agreed audit standards within one English health region. Design: a prospective collaborative audit over twelve months (November 1994 to October 1995) involving all surgeons undertaking CEA within one English health region. Methods: audit standards were agreed by all participating surgeons at the o utset based on existing national guidelines. Data were abstracted from clin ical notes. Outcomes were reviewed by clinicians 30 days post-surgery. A co nfidential individualised report of the results was provided to each surgeo n. A survey of participating surgeons sought to evaluate the audit process. Results: ten surgeons performed 139 CEAs on 134 individuals (64% men). Medi an per surgeon was 12 (range 1-44). Audit standards were generally achieved : 114 (82%) patients had symptomatic carotid stenosis of 70-99%, 14 (10%) w ere asymptomatic. The median time from first referral to hospital to operat ion was 4.8 months (interquartile range 3.0-7.3). The rate of disabling str oke or death at 30 days was 2.2% (95% confidence interval (CI) 0.4-6.4%). S urgeons valued the audit. Conclusions: the study showed that in the study area CEA was performed pred ominantly on high-risk patients with low subsequent surgical mortality.