IP127. Risk Factors for Major Adverse Clinical Events After Carotid Endarterectomy Based on Patient Age and Symptoms

Abstract

Carotid endarterectomy (CEA) is a well-established surgical procedure in the treatment of symptomatic and asymptomatic carotid atherosclerosis. We reviewed the American College of Surgeons National Surgical Quality Improvement Program database to assess which factors contribute to major adverse clinical events (MACEs) in the 30-day postoperative period. The American College of Surgeons National Surgical Quality Improvement Program database was queried among all participating institutions for CEAs performed in 2011 to 2015. Patients’ demographic data, comorbid conditions, preprocedure medication use, and operative variables were analyzed using multivariate logistic regression analysis to determine predictors of postoperative MACEs. There were 17,888 patients who underwent CEA analyzed; the patients were grouped by age (<75 and ≥75 years old) and whether they presented symptomatically (SYM) or asymptomatically (AS) before the procedure. For AS patients <75 years, the rate of stroke, myocardial infarction (MI), death, and MACEs was 1.8%, 1.6%, 0.4%, and 3.6%, respectively; for patients ≥75 years, rates were 1.7%, 2.3%, 0.7%, and 4.3%. The rate of MI was significantly higher in older patients (P = .0133). The odds of postoperative stroke was 73% higher (P < .0011) in diabetics, 57% higher (P = .0109) with American Society of Anesthesiologists (ASA) score 4 or 5, and 34% higher with operative time >2.5 hours (P = .0189). SYM patients ≥75 years had 1.1 times higher risk of postoperative stroke if they had insulin-dependent diabetes (P = .0148). Reintubation and reoperation were associated with increased risk of postoperative stroke in both age groups, whether SYM or AS (P < .0001), as well as postoperative MI (P < .0001). AS patients <75 years had higher likelihood of postoperative MI if they had history of congestive heart failure (P = .0257) and operative time >2.5 hours (P = .0033). SYM patients ≥75 years had 46% higher likelihood of postoperative MI if operative time >2.5 hours (P = .0023). Mortality was higher in AS patients <75 years with ASA score 4 or 5 (P = .0006) and those ≥75 years (P = .0072) and in patients who were reintubated (P < .0001). In SYM patients <75 years, the rate of stroke, MI, death, and MACEs was 4.8%, 1.4%, 0.9%, and 6.3%, respectively. In those ≥75 years, rates were 4.9%, 2.6%, 1.6%, and 7.8%. Older patients had higher rates of MI and MACEs (P = .001 and P= .0103). SYM patients <75 years had higher mortality if they had chronic obstructive pulmonary disease (P = .0002) and diabetes (P = .0062). SYM patients of all ages had higher mortality with postoperative stroke or MI (P < 0.0001). Patients 75 years or older are at increased risk of postoperative MI after CEA regardless of symptomatic status. Diabetes, increased operative time, and ASA score 4 or 5 were associated with higher MACE rates among all age groups.