Comparison of carotid endarterectomy at high- and low-volume hospitals

Background: Population-based studies have demonstrated better outcomes for carotid endarterectomies at high-volume hospitals. Methods: This is a 2-year retrospective review of carotid procedures at two low-volume hospitals (n = 156) and one high-volume hospital (n = 404) in t he metropolitan area of Portland, Oregon. Results: There were no significant differences in 30-day mortality and stro ke rates for carotid endarterectomies when comparing low- and high-volume h ospitals (P = 0.59). These were comparable rates despite the fact that the low-volume hospitals had significantly older patients (P < 0.001), more smo kers (P < 0.001), more patients with an indication of a previous nondisabli ng stroke (P < 0.01), and fewer patients who were asymptomatic (P < 0.01). Conclusion: The regionalization of carotid endarterectomy into high-volume hospitals is not justified by the findings of this study. Carotid endartere ctomy performed by well-trained, experienced surgeons in low-volume hospita ls is a safe procedure. (C) 2001 Excerpta Medica, Inc. All rights reserved.