US nationwide trends in carotid revascularization: hospital outcome and predictors of outcome from 1998 to 2007.

Objectives The goals of the study were to assess US nationwide trends in hospital outcome following carotid endarterectomy ( CEA) and carotid angioplasty and stenting ( CAS) and to determine potential predictors of outcome. Methods The Nationwide Inpatient Sample, constituting a 20% representative and stratified sample of non-federal US hospitals, was analyzed retrospectively from years 1998 to 2007. Results The annual number of CEA decreased (137,877-111,658) and increased for CAS (2318-14,415). Inhospital mortality following CEA decreased from 0.4% to 0.3% ( P < 0.001), whereas long-term facility (LTF) discharge increased from 8.2% to 10.5% ( P < 0.001). Discharge outcome improved for CAS in both categories (mortality 2-0.5%; LTF discharge 10.7-8.3%; both P < 0.001). The trend analysis revealed an increase in patient age and a worsening comorbid profile over time. Age, women, length of stay, atrial fibrillation, and carotid stenosis with infarction were important determinants of unfavorable hospital outcome. Conclusion From a nationwide practice perspective, the number of carotid revascularizations fell by 10%. CEA has resulted in stable hospital mortality rates. Meanwhile, CAS has been increasingly utilized with overall improvement in short-term outcome. Our results further suggest a decrease in the number of patients with treatment-eligible carotid disease over time. However, the increasing prevalence of high-risk comorbidity in the aging population may pose a challenge to revascularization strategies. [ABSTRACT FROM AUTHOR]