Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-18T12:27:03.066Z Has data issue: false hasContentIssue false
  • English
  • Français

Provincial Carotid Endarterectomy Outcomes

Published online by Cambridge University Press:  02 December 2014

Thomas E. Feasby ,
Hude Quan  and
William A. Ghali
Thomas E. Feasby
Affiliation:
Department of Clinical Neurosciences, University of Calgary and the Calgary Health Region, Calgary, Alberta, Canada
Hude Quan
Affiliation:
Department of Community Health Sciences, University of Calgary and the Calgary Health Region, Calgary, Alberta, Canada
William A. Ghali
Affiliation:
Departments of Medicine and Community Health Sciences, and the Centre for Health and Policy Studies, University of Calgary and the Calgary Health Region, Calgary, Alberta, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Outcomes must be measured as a first step toward improving performance. We sought to measure the national and provincial outcomes from carotid endarterectomy (CE) and explain provincial differences.

Methods:

We analyzed a large Canada-wide administrative hospital discharge database of all patients, except those in Québec, receiving CE in 1994-1997 and used logistic regression for risk adjustment to measure adverse outcomes nationally and by province. Our main outcome measures were in-hospital stroke and/or death.

Results:

A total of 14,268 patients underwent CE in the years 1994-1997. The overall death rate was 1.3% and the combined stroke and/or death rate was 4.1%. There was a trend towards improvement over the four years. The provinces of Saskatchewan and Newfoundland had significantly higher adverse event rates for the risk-adjusted combined outcome measure.

Conclusion:

The outcome of CE in Canada is good and showed improvement over four years. However, significant differences in provincial outcomes were found. This suggests that regionalization across provincial boundaries may be needed to promote higher surgeon and hospital case volumes and thus improve outcomes.

Résumé:

RÉSUMÉ:Introduction:

La première étape dans un processus visant à améliorer la performance est l’évaluation des résultats. Notre but était d’évaluer les résultats nationaux et provinciaux de l’endartérectomie carotidienne (EC) et d’expliquer les différences interprovinciales.

Méthodes:

Nous avons analysé une base de données administrative pancanadienne de congés hospitaliers de tous les patients, sauf de ceux du Québec, ayant subi une EC entre 1994 et 1997. Nous avons utilisé l’analyse de régression logistique pour ajuster les données pour le niveau de risque afin d’analyser les résultats défavorables nationaux et provinciaux. Notre principale mesure des résultats était l’accident vasculaire cérébral (AVC) et/ou le décès pendant l’hospitalisation.

Résultats:

Au total, 14 268 patients ont subi une EC entre 1994 et 1997. Le taux de mortalité a été de 1,3% et le taux combiné d’AVC et/ou de décès a été de 4,1%. Ces taux présentaient une tendance à la baisse au cours de ces quatre années. La Saskatchewan et Terre-Neuve avaient un taux significativement plus élevé d’incidents thérapeutiques en ce qui concerne la mesure des résultats combinés, ajustée pour le niveau de risque.

Conclusions:

Les résultats de l’EC sont bons au Canada et se sont améliorés au cours des quatre années de l’étude. Cependant, il existe des différences interprovinciales significatives, ce qui suggère que la régionalisation sans égard aux limites territoriales provinciales pourrait être nécessaire pour promouvoir un volume plus élevé de cas par chirurgien et par hôpital et ainsi améliorer les résultats.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 4 , November 2002 , pp. 333 - 336
Copyright
Copyright © The Canadian Journal of Neurological 2002

References

1. Barnett, HJM, Eliasziw, M, Meldrum, H, Taylor, D. Do the facts and figures warrant a 10-fold increase in the performance of carotid endarterectomy on asymptomatic patients? Neurology 1996;46:603–608.Google Scholar
2. Tu, JV, Hannan, EL, Anderson, GM, et al. The fall and rise of carotid endarterectomy in the United States and Canada. New Eng J Med 1998;339:1441–1447.Google Scholar
3. Feasby, TE, Quan, H, Ghali, WA. Geographic variation in the rate of carotid endarterectomy in Canada. Stroke 2001;32:2417–2422.Google Scholar
4. North American Symptomatic Carotid Endarterectomy Trial Collaborators. The benefit of carotid endarterectomy in symptomatic patients with moderate and severe stenosis. NEJM 1998;339:1415–1425.CrossRefGoogle Scholar
5. Feasby, TE. Endarterectomy for asymptomatic carotid stenosis in the real world. Can J Neurol Sci 2000;27:95–96.Google Scholar
6. Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures. Ottawa: Statistics Canada, 1986, cat. no. 82-562E.Google Scholar
7. Deyo, R, Cherkin, D, Ciol, M. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.Google Scholar
8. Ghali, WA, Quan, H, Brant, R. Risk adjustment using administrative data. Impact of a diagnosis-type indicator. J Gen Intern Med 2001;16:519–524.CrossRefGoogle ScholarPubMed
9. Charlson, M, Pompei, P, Ales, K, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
10. Naylor, CD, Anderson, GM, Goel, V. Patterns of health care in Ontario. The ICES Practice Atlas. Vol. 1. Ottawa: Canadian Medical Association; 1994.Google Scholar
11. Ghali, WA, Quan, H, Brant, R. Coronary artery bypass grafting in Canada: national and provincial mortality trends, 1992-1995. Can Med Assoc J 1998;159:25–31.Google Scholar
12. Naylor, CD, Slaughter, P (Eds). Cardiovascular Health and Services in Ontario: an ICES Atlas. 1st ed. Toronto: ICES; 1999.Google Scholar
13. Donabedian, A. The Definition of Quality and Approaches to its Assessment. Health Administration Press, Ann Arbor, Michigan, 1980.Google Scholar
14. Feasby, TE, Quan, H, Ghali, WA. Hospital and surgeon determinants of carotid endarterectomy outcomes. In press, Arch Neurol 2002.Google Scholar
15. Kucey, DS, Bowyer, B, Iron, K, et al. Determinants of outcome after carotid endarterectomy. J Vasc Surg 1998;28:1050–1058.Google Scholar
16. Kresowik, TF, Bratzler, D, Karp, HR, et al. Multistate utilization, processes, and outcomes of carotid endarterectomy. J Vasc Surg 2001;33:227–235.Google Scholar
17. Ghali, WA, Rothwell, DM, Quan, H, Brant, R, Tu, JV. A Canadian comparison of data sources for coronary artery bypass surgery outcome ‘report cards’. Am Heart J 2000;140:402–408.CrossRefGoogle ScholarPubMed
18. Williams, JI, Young, W. Appendix 1. A summary of studies on the quality of health care administrative databases in Canada. In: Goel, V, Williams, JI, Anderson, GM, Blackstien-Hirsch, P, Fooks, C, Naylor, CD (Eds). Patterns of Health Care in Ontario. The ICES Practice Atlas. 2nd ed. Ottawa: Canadian Medical Association; 1996:339–345.Google Scholar
19. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273:1421–1428.Google Scholar

A correction has been issued for this article:

Erratum