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Carotid endarterectomy national trends over a decade: does sex matter? Ann Vasc Surg 2014 May;28(4):887-92

Date

12/11/2013

Pubmed ID

24321266

Pubmed Central ID

PMC4535711

DOI

10.1016/j.avsg.2013.08.016

Scopus ID

2-s2.0-84899937092   9 Citations

Abstract

BACKGROUND: The objective was to evaluate the difference in timing (if any) of in-hospital carotid endarterectomy (CEA) or outcomes of CEA based on sex among men and women hospitalized for carotid artery disease.

METHODS: This was a retrospective cross-sectional study using the Nationwide Inpatient Sample Database. All patients from 2000-2009 who underwent CEA during their hospitalization were examined. International Classification of Diseases, 9th revision codes were used to identify patients who underwent CEA during hospitalization, stratify asymptomatic and symptomatic patients, determine time in days from admission to CEA, and examine in-hospital complications, including perioperative stroke, cardiac events, and death. Statistical analysis was performed with chi-squared and t-tests. Linear and logistic regression models were used to evaluate relationships between sex and outcomes. The main outcome measures were time from admission to surgery, in-hospital mortality, complications, mean duration of stay, and discharge disposition.

RESULTS: Two hundred twenty-one thousand two hundred fifty three patients underwent CEA during hospitalization. More than 9% (9.2%) had symptomatic carotid artery disease. Among symptomatic patients, bivariate analysis found that women had a longer mean time from admission to surgery (2.8 vs. 2.6 days; P < 0.001) and a longer duration of hospital stay (6.4 vs. 5.9 days; P < 0.001) than their male counterparts. However, there was no difference between men and women with regard to rates of perioperative stroke, cardiac complications, myocardial infarction, or death. Among asymptomatic patients, women had a longer mean time from admission to surgery (0.53 vs. 0.48 days; P < 0.001) and a trend toward increased perioperative stroke (0.6% vs. 0.5%; P = 0.06), but a lower rate of cardiac complications (1.5% vs. 1.7%; P = 0.01) and in-hospital mortality (0.26% vs. 0.31%; P = 0.05). However, on multivariable analysis adjusting for differences in age, elective status, insurance, race, hospital location, hospital region, and hospital teaching status, there was no sex disparity in time from admission to surgery, regardless of symptomatic status. In addition, asymptomatic women were less likely than men to have a cardiac complication (odds ratio [OR]: 0.90; 95% confidence interval [CI]: 0.83-0.97) or in-hospital mortality (OR: 0.83; 95% CI: 0.70-0.98). Symptomatic women were also less likely than men to have a cardiac complication (OR: 0.78; 95% CI: 0.63-0.97).

CONCLUSIONS: In this decade-long national population-based study of hospitalized patients undergoing CEA, women had lower perioperative cardiac morbidity and mortality rates than men. After adjusting for patient, clinical, and hospital factors, there is no discernible difference in timing of CEA based on sex.

Author List

Kuy S, Dua A, Desai SS, Rossi PJ, Seabrook GR, Lewis BD, Patel B, Kuy S, Lee CJ, Subbarayan R, Brown KR

Authors

Kellie R. Brown MD Professor in the Surgery department at Medical College of Wisconsin
Brian D. Lewis MD Professor in the Surgery department at Medical College of Wisconsin
Peter J. Rossi MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Carotid Artery Diseases
Chi-Square Distribution
Cross-Sectional Studies
Endarterectomy, Carotid
Female
Heart Diseases
Hospital Mortality
Humans
Length of Stay
Linear Models
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Retrospective Studies
Risk Assessment
Risk Factors
Sex Factors
Stroke
Time Factors
Treatment Outcome
United States
jenkins-FCD Prod-398 336d56a365602aa89dcc112f077233607d6a5abc