A Regional Collaborative Audit of the Practice and Outcome of Carotid Endarterectomy in the United Kingdom

Abstract

Objectives to evaluate performance and outcome of carotid endarterectomy (CEA) against agreed audit standards within one English health region. Design a prospective collaborative audit over twelve months (November 1994 to October 1995) involving all surgeons undertaking CEA within one English health region. Methods audit standards were agreed by all participating surgeons at the outset based on existing national guidelines. Data were abstracted from clinical notes. Outcomes were reviewed by clinicians 30 days post-surgery. A confidential individualised report of the results was provided to each surgeon. A survey of participating surgeons sought to evaluate the audit process. Results ten surgeons performed 139 CEAs on 134 individuals (64% men). Median per surgeon was 12 (range 1–44). Audit standards were generally achieved: 114 (82%) patients had symptomatic carotid stenosis of 70–99%, 14 (10%) were asymptomatic. The median time from first referral to hospital to operation was 4.8 months (interquartile range 3.0–7.3). The rate of disabling stroke or death at 30 days was 2.2% (95% confidence interval (CI) 0.4–6.4%). Surgeons valued the audit.Conclusions the study showed that in the study area CEA was performed predominantly on high-risk patients with low subsequent surgical mortality.