This article is more than 5 years old. Information may no longer be current.
Carotid stenting outcomes vary widely across US hospitals
Click Here to Manage Email Alerts
Hospitals performing carotid artery stenting vary considerably in rates of in-hospital stroke or death — from 0% to 18% overall and from 1.2% to 4.7% when accounting for variation in health of patients at admission, according to a new report from the American College of Cardiology’s CARE Registry.
Researchers analyzed data on 19,381 carotid artery stenting (CAS) procedures performed from 2005 to 2013 at 188 U.S. hospitals. Each center performed more than five CAS procedures.
“As CAS is increasingly being used throughout the United States, assessing hospital variation in CAS outcomes is critical to understanding and improving the quality of care for patients with carotid artery disease,” Beau M. Hawkins, MD, a cardiologist at the University of Oklahoma Health Sciences Center, and colleagues wrote.
Hawkins and colleagues used a validated prediction model and hospital-level random effects to estimate unadjusted and risk-standardized rates of in-hospital stroke or death for each hospital.
The overall unadjusted in-hospital stroke or death rate was 2.4% across the entire cohort. The researchers observed wide variation in procedural outcomes, from 0% to more than 18%. After adjustment for variation in risk factors, including age, prior stroke, impending major surgery and atrial flutter, in-hospital stroke or death rates ranged from 1.2% to 4.7%. Low-tertile hospitals had adjusted rates of 1.2% to 2.2%, whereas high-tertile hospitals had adjusted rates of 2.5% to 4.7%.
The researchers calculated a median OR of 1.51 (95% CI, 1.28-1.71). According to the researchers, this means “there was, on average, a 50% difference in the odds of experiencing [in-hospital stroke or death] between two randomly selected hospitals treating the identical patient,” they wrote.
Operator or hospital volume did not significantly predict outcomes after adjustment. This is in contrast to other studies. According to the researchers, this difference may be related to therapeutic advances and improved patient selection. They also noted that hospitals participating in the CARE Registry may have more comprehensive measures in place to promote patient safety or may have more rigorous credentialing standards for providers performing CAS.
“These data suggest that substantial quality differences may exist among U.S. hospitals that offer CAS,” the researchers concluded. “… Future work is needed to identify the sources of this variation and develop initiatives to improve patient outcomes.” – by Katie Kalvaitis
Disclosure: This research was supported by the ACC Foundation’s NCDR. Hawkins reports no relevant financial disclosures.
Click Here to Manage Email Alerts