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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Article info
Publication history
Published online: July 03, 2014
Accepted:
June 10,
2014
Received in revised form:
June 10,
2014
Received:
March 25,
2014
Footnotes
Drs. Badheka, Chothani, Panaich, Mehta, and Patel contributed equally to this work.
No study-specific funding was used to support this work. The authors are solely responsible for the study design, conduct and analyses, and drafting and editing of the manuscript and its final contents. No statement should be construed as an official position of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. All authors had access to the data and a role in writing the manuscript.
See page 939 for disclosure information.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Factors Affecting Outcome of Carotid Artery StentingAmerican Journal of CardiologyVol. 114Issue 9
- PreviewWe 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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