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Impact of Symptoms, Gender, Co-Morbidities, and Operator Volume on Outcome of Carotid Artery Stenting (from the Nationwide Inpatient Sample [2006 to 2010])

      The increase in the number of carotid artery stenting (CAS) procedures over the last decade has necessitated critical appraisal of procedural outcomes and patterns of utilization including cost analysis. The main objectives of our study were to evaluate the postprocedural mortality and complications after CAS and the patterns of resource utilization in terms of length of stay (LOS) and cost of hospitalization. We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 2006 to 2010 using the International Classification of Diseases, Ninth Revision, procedure code of 00.63 for CAS. Hierarchical mixed-effects models were generated to identify the independent multivariate predictors of in-hospital mortality, procedural complications, LOS, and cost of hospitalization. A total of 13,564 CAS procedures (weighted n = 67,344) were analyzed. The overall postprocedural mortality was low at 0.5%, whereas the complication rate was 8%, both of which remained relatively steady over the time frame of the study. Greater postoperative mortality and complications were noted in symptomatic patients, women, and those with greater burden of baseline co-morbidities. A greater operator volume was associated with a lower rate of postoperative mortality and complications, as well as shorter LOS and lesser hospitalization costs. In conclusion, the postprocedural mortality after CAS has remained low over the recent years. Operator volume is an important predictor of postprocedural outcomes and resource utilization.
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      Linked Article

      • Factors Affecting Outcome of Carotid Artery Stenting
        American Journal of CardiologyVol. 114Issue 9
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          We read the report published by Badheka et al1 regarding the impact of symptoms, gender, co-morbidities, and operator volume on the outcome of carotid artery stenting. The investigators convincingly demonstrated that operator volume is an important predictor of postprocedural outcomes and resource utilization. There have been concerns regarding the accuracy of Nationwide Inpatient Sample in studying carotid stenting and carotid enderarterectomy, raised by several investigators in the past.2,3 These issues might be related to inadequate documentation of preprocedural symptoms and periprocedural strokes in the medical records, leading to subsequent coding errors in the hospital discharge abstracts from which Nationwide Inpatient Sample data are extracted.
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