Institutional peer review can reduce the risk and cost of carotid endarterectomy

Hypothesis: Surgeon-directed institutional peer review, associated with pos itive physician feedback, can decrease the morbidity and mortality rates as sociated with carotid endarterectomy. Design: Case series. Setting: Tertiary care university teaching hospital. Patients/Interventions: All patients undergoing carotid endarterectomy at o ur institution during a 5-year period ending August 1998. Results: Stroke rate decreased from 3.8% (1993-1994) to 0% (1997-1998). The mortality rate decreased from 2.8% (1993-1994) to 0% (1997-1998). Length o f stay decreased from 4.7 days (1993-1994) to 2.6 days (1997-1998). The tot al cost decreased from $13344 (1993-1994) to $9548 (1997-1998). Conclusions: An objective, confidential peer review process that provides o ngoing feedback of performance to surgeons and documents that performance i n relationship with that of peers seems to be effective in reducing the mor bidity and mortality rate associated with carotid endarterectomy. In additi on, the review process lowered the hospital cost of performing carotid enda rterectomy.