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Provincial Carotid Endarterectomy Outcomes

Published online by Cambridge University Press:  02 December 2014

Thomas E. Feasby ,
Hude Quan  and
William A. Ghali
Thomas E. Feasby
Affiliation:
Department of Clinical Neurosciences, University of Calgary and the Calgary Health Region, Calgary, Alberta, Canada
Hude Quan
Affiliation:
Department of Community Health Sciences, University of Calgary and the Calgary Health Region, Calgary, Alberta, Canada
William A. Ghali
Affiliation:
Departments of Medicine and Community Health Sciences, and the Centre for Health and Policy Studies, University of Calgary and the Calgary Health Region, Calgary, Alberta, Canada
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Abstract

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Background:

Outcomes must be measured as a first step toward improving performance. We sought to measure the national and provincial outcomes from carotid endarterectomy (CE) and explain provincial differences.

Methods:

We analyzed a large Canada-wide administrative hospital discharge database of all patients, except those in Québec, receiving CE in 1994-1997 and used logistic regression for risk adjustment to measure adverse outcomes nationally and by province. Our main outcome measures were in-hospital stroke and/or death.

Results:

A total of 14,268 patients underwent CE in the years 1994-1997. The overall death rate was 1.3% and the combined stroke and/or death rate was 4.1%. There was a trend towards improvement over the four years. The provinces of Saskatchewan and Newfoundland had significantly higher adverse event rates for the risk-adjusted combined outcome measure.

Conclusion:

The outcome of CE in Canada is good and showed improvement over four years. However, significant differences in provincial outcomes were found. This suggests that regionalization across provincial boundaries may be needed to promote higher surgeon and hospital case volumes and thus improve outcomes.

Résumé:

RÉSUMÉ:Introduction:

La première étape dans un processus visant à améliorer la performance est l’évaluation des résultats. Notre but était d’évaluer les résultats nationaux et provinciaux de l’endartérectomie carotidienne (EC) et d’expliquer les différences interprovinciales.

Méthodes:

Nous avons analysé une base de données administrative pancanadienne de congés hospitaliers de tous les patients, sauf de ceux du Québec, ayant subi une EC entre 1994 et 1997. Nous avons utilisé l’analyse de régression logistique pour ajuster les données pour le niveau de risque afin d’analyser les résultats défavorables nationaux et provinciaux. Notre principale mesure des résultats était l’accident vasculaire cérébral (AVC) et/ou le décès pendant l’hospitalisation.

Résultats:

Au total, 14 268 patients ont subi une EC entre 1994 et 1997. Le taux de mortalité a été de 1,3% et le taux combiné d’AVC et/ou de décès a été de 4,1%. Ces taux présentaient une tendance à la baisse au cours de ces quatre années. La Saskatchewan et Terre-Neuve avaient un taux significativement plus élevé d’incidents thérapeutiques en ce qui concerne la mesure des résultats combinés, ajustée pour le niveau de risque.

Conclusions:

Les résultats de l’EC sont bons au Canada et se sont améliorés au cours des quatre années de l’étude. Cependant, il existe des différences interprovinciales significatives, ce qui suggère que la régionalisation sans égard aux limites territoriales provinciales pourrait être nécessaire pour promouvoir un volume plus élevé de cas par chirurgien et par hôpital et ainsi améliorer les résultats.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 4 , November 2002 , pp. 333 - 336
Copyright
Copyright © The Canadian Journal of Neurological 2002

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A correction has been issued for this article:

Erratum