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dc.contributor.authorEslami, Mohammad H.
dc.contributor.authorMcPhee, James T.
dc.contributor.authorSimons, Jessica P.
dc.contributor.authorSchanzer, Andres
dc.contributor.authorMessina, Louis M.
dc.date2022-08-11T08:10:58.000
dc.date.accessioned2022-08-23T17:27:01Z
dc.date.available2022-08-23T17:27:01Z
dc.date.issued2011-02-26
dc.date.submitted2011-06-20
dc.identifier.citationJ Vasc Surg. 2011 Feb;53(2):307-15. Epub 2010 Nov 18. <a href="http://dx.doi.org/10.1016/j.jvs.2010.08.080">Link to article on publisher's site</a>
dc.identifier.issn0741-5214 (Linking)
dc.identifier.doi10.1016/j.jvs.2010.08.080
dc.identifier.pmid21093200
dc.identifier.urihttp://hdl.handle.net/20.500.14038/49766
dc.description.abstractOBJECTIVE: This study compared, at a national level, trends in utilization, mortality, and stroke after carotid angioplasty and stenting (CAS) and carotid endarterectomy (CEA) from 2005 to 2007. METHODS: The Nationwide Inpatient Sample (NIS) was queried for patient discharges with International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes for CAS and CEA. The primary outcomes were in-hospital mortality, stroke, hospital charges, and discharge disposition. Subgroup analyses were performed to evaluate these outcomes by neurologic presentation using chi(2) and multivariable logistic regression. RESULTS: Of the 404,256 discharges for carotid revascularization, CAS utilization was 66% higher in 2006 than in 2005 (9.3% vs 14%, P = .0004). Crude mortality, stroke, and median charges remained higher for CAS than for CEA; discharge to home was more common after CEA. Results improved from 2005 to 2007. By logistic regression of the total cohort from 2005 to 2006, CAS was independently predictive of mortality (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.08-2.00; P < .0001). Independent predictors of stroke included CAS (OR, 1.43; 95% CI, 1.18-1.73; P < .0001) and symptomatic disease (OR, 2.4; 95% CI, 2.06-2.93;P < .0001). Among subgroups based on neurological presentation, regression showed that CAS significantly increased the odds of stroke in asymptomatic patients (OR, 1.6; 95% CI, 1.2-2.0; P = .0003). Among symptomatic patients, CAS increased the odds of in-hospital death (OR, 3.0; 95% CI, 1.7-5.1, P < .0001) and trended toward significance for stroke (OR, 1.7; 95% CI, 1.0-2.8; P = .0569). CONCLUSION: Utilization of CAS has increased from the years 2005 to 2007 with some improvements in the outcome. Despite improvements in outcome, resource utilization remains significantly higher for CAS than CEA. All rights reserved.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=21093200&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.jvs.2010.08.080
dc.subjectAged
dc.subjectAngioplasty
dc.subjecteffects
dc.subjectCarotid Artery Diseases
dc.subjectChi-Square Distribution
dc.subjectEndarterectomy, Carotid
dc.subjectFemale
dc.subjectHealth Resources
dc.subjectHome Care Services
dc.subjectHospital Costs
dc.subjectHospital Mortality
dc.subjectHumans
dc.subjectLength of Stay
dc.subjectLogistic Models
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectOdds Ratio
dc.subject*Outcome and Process Assessment (Health Care)
dc.subjectnumerical data
dc.subjectPatient Discharge
dc.subjectRetrospective Studies
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.subjectSkilled Nursing Facilities
dc.subjectStents
dc.subjectStroke
dc.subjectTime Factors
dc.subjectTreatment Outcome
dc.subjectUnited States
dc.subjectSurgery
dc.titleNational trends in utilization and postprocedure outcomes for carotid artery revascularization 2005 to 2007
dc.typeJournal Article
dc.source.journaltitleJournal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
dc.source.volume53
dc.source.issue2
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/surgery_pp/35
dc.identifier.contextkey2067738
html.description.abstract<p>OBJECTIVE: This study compared, at a national level, trends in utilization, mortality, and stroke after carotid angioplasty and stenting (CAS) and carotid endarterectomy (CEA) from 2005 to 2007.</p> <p>METHODS: The Nationwide Inpatient Sample (NIS) was queried for patient discharges with International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes for CAS and CEA. The primary outcomes were in-hospital mortality, stroke, hospital charges, and discharge disposition. Subgroup analyses were performed to evaluate these outcomes by neurologic presentation using chi(2) and multivariable logistic regression.</p> <p>RESULTS: Of the 404,256 discharges for carotid revascularization, CAS utilization was 66% higher in 2006 than in 2005 (9.3% vs 14%, P = .0004). Crude mortality, stroke, and median charges remained higher for CAS than for CEA; discharge to home was more common after CEA. Results improved from 2005 to 2007. By logistic regression of the total cohort from 2005 to 2006, CAS was independently predictive of mortality (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.08-2.00; P < .0001). Independent predictors of stroke included CAS (OR, 1.43; 95% CI, 1.18-1.73; P < .0001) and symptomatic disease (OR, 2.4; 95% CI, 2.06-2.93;P < .0001). Among subgroups based on neurological presentation, regression showed that CAS significantly increased the odds of stroke in asymptomatic patients (OR, 1.6; 95% CI, 1.2-2.0; P = .0003). Among symptomatic patients, CAS increased the odds of in-hospital death (OR, 3.0; 95% CI, 1.7-5.1, P < .0001) and trended toward significance for stroke (OR, 1.7; 95% CI, 1.0-2.8; P = .0569).</p> <p>CONCLUSION: Utilization of CAS has increased from the years 2005 to 2007 with some improvements in the outcome. Despite improvements in outcome, resource utilization remains significantly higher for CAS than CEA. All rights reserved.</p>
dc.identifier.submissionpathsurgery_pp/35
dc.contributor.departmentDepartment of Surgery
dc.source.pages307-15


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