Predictors of 30-day postoperative stroke or death after carotid endarterectomy using the 2012 carotid endarterectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database

Abstract

This study used a recently released procedure-targeted multicenter data source to determine independent predictors of postoperative stroke or death in patients undergoing carotid endarterectomy (CEA) for carotid artery stenosis. The 2012 CEA-targeted American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was used for this study. Patient, disease, and procedure characteristics of patients undergoing CEA were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for 30-day postoperative stroke/death or other major complications. The analysis included 3845 patients undergoing CEA (58.1% with asymptomatic and 41.9% with symptomatic carotid disease). The overall 30-day postoperative stroke/death rate was 3.0% (1.9% in asymptomatic patients, 4.6% in symptomatic patients). The variables that maintained an independent association with postoperative stroke/death after adjustment for other known patient-related and procedure-related factors were age ≥80 years, active smoking, contralateral internal carotid artery stenosis of 80% to 99%, emergency procedure status, preoperative stroke, presence of one or more ACS NSQIP-defined high-risk characteristics (including any or all of New York Heart Association class III/IV congestive heart failure, left ventricular ejection fraction <30%, recent unstable angina, or recent myocardial infarction), and operative time ≥150 minutes. After adjustment for a comprehensive array of patient-related and procedure-related variables of particular import to patients with carotid artery stenosis, we have identified several factors that are independently associated with early stroke or death after CEA. These factors are generally related to the comorbid condition of CEA patients and to specific characteristics of their carotid disease, and not to technical features of the CEA procedure. Knowledge of these factors will assist surgeons in selecting appropriate patients for this procedure.