Abstract TMP60: Trends in Neurophysiologic Intraoperative Monitoring and Occurrence of Stroke at the Time of Hospitalization for Carotid Endarterectomy

Abstract

Background: intraoperative neurophysiological monitoring (IoNM) is a valuable technique for determining the need for selective intraoperative shunting and prevention of perioperative stroke in patients undergoing carotid endarterectomy (CEA). Methods: We aimed to describe the trends of intraoperative monitoring utilization using the US-representative 2006-2015 National Inpatient Sample database. We sought to identify associations of patient’s demographics with outcomes with an adjusted multivariable logistic regression model. Results: Between 2006-2014, there were a total of 11003 endarterectomies included in our analysis, most commonly performed in men 6764 (61.5%), and women 4239 (38.5%) mostly older than 65 years old. Intraoperative monitoring was used in 266 cases (2.45%) equally across genders, 168 (2.5%) man, 98 (2.3%) women. Nearly 80.8% undergoing CEA and IoNM were white, 8.7% black, 5.7% Hispanic with no differences of IoNM use across race. No difference between primary payer, location/teaching status or size of the hospital were observed. The use of IoNM during CEA was more frequent in the Midwest region: 32.9% (89), Northeast: 28% (74), South: 21.4% (57), and West: 17.6% (46), p=0.0000. The rate of utilization of IoNM increased across the years, 2006/08 (0.06%), 2009/11 (2.1%) and 2012/14 (4.6%). p=0.0000. Unadjusted rates of in-hospital death were not associated with IoNM. Mean length of stay(LOS) of ECA with IoNM was 8 days (95% CI, 7.36-8.76) and IoNM without ECA was 7.25 (95% CI, 7.10-7.38). Adjusted Mortality did not differ in time. During 2009-2011: aOR 0.60 (95% CI, 0.36-0.98) and 2012-2014: aOR 0.50, (95% CI, 0.29-0.86) were associated with lower odds of using Intraoperative monitoring. The Charlson Comorbidity Index aOR 1.2 (95% CI, 1.09-1.33) and Length of stay aOR 1.06 (95% CI, 1.04-1.08) Conclusions: The percent of endarterectomies performed with IoNM has increased over the years; however, this trend does not seem to impact LOS and in-hospital mortality. This might be explained by the overall low rate of utilization, with documentation of its use in only 5.2% of CEA performed in 2014. Despite being a highly specific test in predicting neurological outcomes, the impact on perioperative stroke prevention is perhaps undervalued.