This article is more than 5 years old. Information may no longer be current.
Surgeons perform most carotid stenting procedures in US
In the United States, the majority of carotid stenting procedures are performed by surgeons. However, volume of cases performed by a surgeon or interventional cardiologist may be a stronger predictor of patient outcomes than specialty of the provider performing the intervention, according to a new report.
The number of vascular surgeons performing carotid stenting has increased in recent years. Previously published data from the CREST trial, for example, demonstrated that carotid stenting yielded similar outcomes to carotid endarterectomy. “However, there is still controversy about the appropriate training and experience required to safely perform this procedure,” researchers wrote in the Journal of Vascular Surgery.
Researchers conducted an observational study to investigate the performance of carotid stenting by specialty and case volume. The study included 20,663 inpatients with carotid stenosis who underwent carotid stenting from 2004 to 2011. Data were culled from the Nationwide Inpatient Sample database.
Cases were grouped based on the provider who performed the procedure, location of hospital and procedure volume.
For this study, surgeons were classified as those who had also performed one or more elective carotid endarterectomy procedures and femoral-popliteal bypass or arteriovenous fistula within 1 year. Interventionalists were classified as physicians who performed carotid stenting, but not the other open vascular surgical procedures during the same period.
Stroke, MI and 30-day mortality served as the primary outcome measures. Secondary measures included length of stay and hospital costs.
Seventy-four percent of cases were performed by providers classified as surgeons compared with 26% performed by interventionalists.
The most common place carotid stenting was performed was at a hospital in an urban location (96.5%). Carotid stenting was performed at designated teaching institutions in 61.5% of cases.
Postoperative outcomes were similar for procedures performed by surgeons or interventionalists. Stroke was reported in 4.3% of surgeon cases vs. 4.1% of interventionalist cases, MI was reported in 2.1% of surgeon cases vs. 2.1% of interventionalist cases and mortality was 0.84% in surgeon cases vs. 1.03% in interventionalist cases, according to unadjusted analyses.
When the researchers examined outcomes associated with a 10-unit volume per year difference among the centers, they found no significant difference in mortality and MI, and a significantly lower risk for stroke at higher-volume centers (adjusted risk = 0.97; 95% CI, 0.94-0.99).
In other results, procedures performed by surgeons yielded an average length of hospital stay of 2.81 days vs. 3.08 for procedures performed by interventionalists (P = .001). Total hospital charges were lower for surgeon cases compared with interventionalist cases ($48,087 vs. $51,718; P = .003).
Multivariable analyses adjusted for patient age, sex, race/ethnicity, history of stroke, Charlson comorbidity index score, and hospital location and type produced similar results.
“The volume of cases performed by a provider, and, hence, experience rather than the provider’s specialty, appears to be a stronger predictor of favorable outcomes for carotid stenting,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.