Impact of race on the outcome of carotid endarterectomy - A population-based analysis of 9,842 recent elective procedures

Objective To examine the influence of race and other potentially confounding variable s on the outcome of carotid endarterectomy (CEA). Summary Previous studies have demonstrated that CEA is performed less frequently in black patients, although little attention has been focused on the influenc e of race on the outcome of surgery. Methods The Maryland Health Services Cost Review Commission database was reviewed t o identify all elective CEA procedures performed in ail nonfederal acute ca re hospitals in the state from 1990 through 1995 to examine the influence d f race and other factors on the rates of in-hospital complications, in-hosp ital stroke, length of stay, and total hospital charges. Results Carotid endarterectomy was performed in 9,219 (94%) white and 623 (6%) blac k patients during this period. The in-hospital stroke rate was 1.7%-3.1% am ong black patients and 1.6% among white patients. Black patients had a long er length of stay and higher mean hospital charges than white patients. Mul tivariate logistic regression analysis identified black race as an independ ent risk factor for in-hospital stroke. Performance of CEA by a high-volume surgeon was protective for the combined occurrence of in-hospital stroke o r death, and whites were more than twice as likely to undergo surgery perfo rmed by high-volume surgeons. Conversely, undergoing surgery in a low-volum e hospital was associated with in-hospital stroke, and blacks were four tim es as likely to use low-volume hospitals. Conclusions Black patients who underwent elective CEA in Maryland from 1990 to 1995 had an increased incidence of in-hospital stroke, a longer hospital stay, and higher hospital charges than whites. Slack race was identified as an indepe ndent risk factor for in-hospital stroke, although the reasons for this inf luence of race on outcome are undefined. The authors' observations also sug gest the possibility of limited access to optimal surgical care among black s, and this issue warrants further study.