Abstract
Carotid endarterectomy (CEA) is a common surgical procedure. Its efficacy in the prevention
of stroke has been proven by multiple clinical trials including North American Symptomatic
Carotid Endarterectomy Trial and Asymptomatic Carotid Atherosclerosis Study. Currently,
there is a wide variability in the technique of this operation. This study was performed
to determine the variability of CEA at the University of Kentucky Medical Center with
a focus on cost and short-term outcome. We reviewed the charts of a consecutive series
of 349 patients undergoing CEA at our institution. We analyzed the variability in
shunt used across surgeons, intraoperative variables, cost, and outcome. Data on 374
procedures on 349 patients who underwent CEA showed shunt utilization varied significantly
by surgeon from 3 to 94%. Patch utilization also varied significantly by surgeon.
Two in-hospital deaths occurred in the shunt group (1.3%) and none in the no-shunt
group. Shunt placement was associated with 1 hour 24 minutes increase in operative
time from 2 hours 3 minutes in the no-shunt group to 3 hours 27 minutes in the shunt
group (t test, p < 0.01). Shunt placement was associated with a 1.74-day increase in length of stay,
from 2.97 days in the no-shunt group to 4.71 days in the shunt group. There was no
significant difference in the cost of procedure in these two groups: no-shunt $11,510 ± $3,977,
shunt group $11,479 ± $4,030. This study showed no significant difference in cost
or outcome between various techniques.
Keywords
carotid endarterectomy - stroke - stenosis - shunt - patch - cost analysis - outcomes
- mortality - morbidity
