The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Carotid Endarterectomy for Elderly Patients: Predicting Complications

Robert H. Brook, MD, ScD; Rolla Edward Park, PhD; Mark R. Chassin, MD; Jacqueline Kosecoff, PhD; Joan Keesey, BA; and David H. Solomon, MD
[+] Article, Author, and Disclosure Information

Grant Support: By the American Association of Retired Persons, The Commonwealth Fund, The John A. Hartford Foundation, the Health Care Financing Administration of the U.S. Department of Health and Human Services, The Pew Memorial Trust, and the Robert Wood Johnson Foundation. The opinions, conclusions, and proposals in the text are those of the authors alone and do not necessarily represent the views of any of these organizations, The Rand Corporation, or the University of California.

Requests for Reprints: Robert H. Brook, MD, ScD, The Rand Corporation, 1700 Main Street, Santa Monica, CA 90406.

Current Author Addresses: Drs. Brook and Park and Ms. Keesey: The Rand Corporation, 1700 Main Street, Santa Monica, CA 90406.

Drs. Chassin and Kosecoff: Value Health Sciences, 1448 15th Street, Suite 202, Santa Monica, CA 90404.

Dr. Solomon: UCLA Medical Center, 10833 Le Conte Avenue, 32-144 CHS. Los Angeles, CA 90024-1687.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;113(10):747-753. doi:10.7326/0003-4819-113-10-747
Text Size: A A A

Objective: To determine whether the complication or death rate from carotid endarterectomy can be predicted from hospital and physician structural variables, such as the hospital's teaching status or the number of endarterectomies done by the surgeon per year.

Design: Survey of medical records. After controlling for the severity of the patient's condition on the basis of data in the medical record at the time of the endarterectomy, regression analyses were used to predict the postoperative stroke, heart attack, and 30-day death rate as a function of patient, physician, and hospital characteristics.

Setting: Three geographic areas (states or large parts of states; average population, 3 million) in the United States.

Patients: Random sample of 1302 patients 65 years of age or older having carotid endarterectomy in 1981.

Intervention: Carotid endarterectomy.

Measurements and Main Results: Of 1302 patients, 11.3% had a postoperative stroke or heart attack or died within 30 days of the operation. Patient age, race, income, and gender; physician volume, board certification status, and age; and hospital size, for-profit status, ownership, and teaching status were not significantly related to the postoperative complication or death rate. If the surgeon was a graduate of a foreign, but not a Western European or Canadian, medical school, however, the average complication or death rate rose from 10.4% to 19.6% (P < 0.05).

Conclusions: The effectiveness of carotid endarterectomy depends heavily on its complication rate. Because complications after surgery cannot, in general, be predicted from structural variables, referring physicians cannot rely solely on the surgeon's experience and qualifications when recommending a carotid endarterectomy. The surgeon's and the hospital's actual postoperative complication and death rate should be considered.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.