CAR 4. Modifiable Factors That Reduce Postoperative Complications After Carotid Endarterectomy

Abstract

The benefit of prophylactic carotid endarterectomy (CEA) is reduced by postoperative complications. The purpose of this study was to define modifiable factors that could improve outcomes after CEA. The Vascular Quality Initiative CEA registry was analyzed for modifiable factors associated with reduced postoperative complications (neurologic events [ie, transient ischemic attack or stroke] and return to operating room [RTOR] for a bleeding or neurologic event). A multivariate logistic regression analysis was used to account for baseline differences. There were 70,986 patients in the registry who were analyzed for RTOR and postoperative neurologic events. The preferred patch material was bovine pericardium in 77%, Dacron in 19%, vein in 2%, and polytetrafluoroethylene (PTFE) in 2%. Type of closure and use of protamine were found to correlate with complications. PTFE and primary closure had a higher rate of RTOR than bovine pericardium, Dacron, or vein (Table). PTFE, primary closure, and vein had higher rates of neurologic events than bovine pericardium or Dacron (Table). After clustered multivariable analysis, the use of bovine pericardium compared with Dacron, PTFE, vein, and primary closure was associated with reduced RTOR (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.56-0.89; P < .01), as was protamine use (OR, 0.74; 95% CI, 0.60-0.91; P < .01). Bovine pericardium (OR, 0.59; 95% CI, 0.47-072; P < .01) and Dacron closure (OR, 0.56; 95% CI, 0.43-0.74; P < .01) were both associated with reduced postoperative neurologic events. The use of bovine pericardium for closure and protamine for heparin reversal is associated with reduced rates of postoperative complications after CEA.TableIncidence of postoperative events analyzed by type of closureRTOR, %Stroke or TIA, %Bovine pericardium (n = 51,460)1.81.5Dacron (n = 12,349)2.01.5Vein (n = 1459)1.81.9PTFE (n = 1638)2.82.8Primary closure (n = 4051)2.62.8P value<.01<.01PTFE, Polytetrafluoroethylene; RTOR, return to operating room; TIA, transient ischemic attack. Open table in a new tab