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Carotid Endarterectomy for Asymptomatic Patients: Assessing Results of a Quantitative Synthesis

Published online by Cambridge University Press:  10 March 2009

John C. Langenbrunner
Affiliation:
Office of Management and Budget, Washington, DC
Paul M. Wortman
Affiliation:
State University of New York, Stony Brook
William H. Yeaton
Affiliation:
University of Michigan School of Public Health
James J. Holloway
Affiliation:
Lakeside Medical Center, Chicago

Abstract

Carotid endarterectomy (CE) surgery for asymptomatic patients remains controversial despite hundreds of published studies and recent randomized trials. Safety and efficacy are assessed using a quantitative synthesis method derived from meta-analysis and a “critical multiplist” inference approach. In addition, multivariate analyses reveal that use of a surgical shunt could further improve CE outcomes. Methods are examined for both their “confirmatory” and “exploratory” value.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1993

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References

REFERENCES

1.Ad Hoc Committee on Carotid Surgery Standards of the Stroke Council, American Heart Association. Special Report. Circulation, 1989, 79, 472–74.Google Scholar
2.Agency for Health Care Policy and Research. Carotid endarterectomy (revised). Publiction AHCPR 91–0029. Rockville, MD: U.S. Public Health Service, 07 1991.Google Scholar
3.Antiplatelet Trialists’ Collaboration. Secondary prevention of vascular disease by prolonged antiplatelet treatment. British Medical Journal, 1988, 296, 320–31.CrossRefGoogle Scholar
4.Baker, W. H., Littooy, F. N., Hayes, A. C., et al. Carotid endarterectomy without a shunt: The control series. Journal of Vascular Surgery, 1984, 1, 5054.CrossRefGoogle ScholarPubMed
5.Bauer, R. B., Meyer, J. S., Fields, W. S., et al. Joint study of extracranial arterial occlusion: Progress report of controlled study of long-term survival in patients with and without operation. Journal of the American Medical Association, 1969, 208, 509–18.CrossRefGoogle Scholar
6.Blumberg, M. S.Risk-adjusting health care outcome: A methodologic review. Medical Care Review, 1986, 43, 351–96.CrossRefGoogle ScholarPubMed
7.Brook, R. H., Chassin, M. R., Fink, A., et al. A method for the detailed assessment of the appropriateness of medical technologies. International Journal of Technology Assessment in Health Care, 1986, 2, 5363.CrossRefGoogle ScholarPubMed
8.Buche, M., Grenier, Y., Schoevaerdts, J. C., et al. Comparative results after endarterectomy of the internal carotid artery performed with or without a shunt. Journal of Cardiovascular Surgery, 1988, 29, 428–31.Google ScholarPubMed
9.Callow, A. D., Caplan, L. R., Correll, J. W., et al. Carotid endarterectomy: What is its current status? American Journal of Medicine, 1988, 85, 835–38.CrossRefGoogle ScholarPubMed
10.Chassin, M. R., Brook, R. H., Park, R. E., et al. Variations in the use of medical and surgical services by the Medicare population. New England Journal of Medicine, 1986, 314, 285–90.CrossRefGoogle ScholarPubMed
11.Chassin, M. R., Kosecoff, J., Solomon, D. H., et al. Does inappropriate use explain geographic variations in the use of health services? A study of three procedures. Journal of the American Medical Association, 1987, 258, 2533–37.Google Scholar
12.Cook, T. D. & Campbell, D. T.Quasi-experimentation: Design and analysis issues for field settings. Chicago, IL: Rand-McNally, 1979.Google Scholar
13.Cook, T. D. & Leviton, L. C.Reviewing the literature: A comparison of traditional methods with meta-analysis. Journal of Personality, 1980, 48, 449–72.CrossRefGoogle Scholar
14.Dosick, S. M., Whalen, R. C., Gale, S. S., & Brown, O. W.Carotid endarterectomy in the stroke patient: Computerized axial tomography to determine timing. Journal of Vascular Surgery, 1985, 2, 214–17.CrossRefGoogle ScholarPubMed
15.Dyken, M. L. & Pokras, R.The performance of endarterectomy for disease of the extracranial arteries of the head. Stroke, 1984, 15, 948–50.CrossRefGoogle ScholarPubMed
16.Eddy, D. M.Confidence profiles: A quantitative method for assessing health technologies. Durham, NC: Duke University, Center for Health Policy Education and Research, 1986.Google Scholar
17.European Carotid Surgery Trialists’ Collaborative Group. MRC carotid surgery trial: Interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet, 1991, 337, 1235–43.CrossRefGoogle Scholar
18.Fields, W. S., Maslenikov, V., Meyer, J. S., et al. Joint study of extracranial occlusion. Journal of the American Medical Association, 1970, 210, 19932003.CrossRefGoogle Scholar
19.Fink, A., Kosecoff, J., Chassin, M., & Brook, R.Consensus methods: Characteristics and guidelines for use. American Journal of Public Health, 1984, 74, 979–83.CrossRefGoogle ScholarPubMed
20.Fisher, E. S., Malenka, D. J., Solomon, N. A., et al. Risk of carotid endarterectomy in the elderly. American Journal of Public Health, 1989, 12, 1617–20.CrossRefGoogle Scholar
21.Flood, A. B., Scott, W. R., Ewy, W., & Forrest, W. H.Effectiveness in professional organizations: The impact of surgeons and surgical staff organizations on the quality of care in hospitals. Health Services Research, 1982, 4, 341–66.Google Scholar
22.Glass, G. V.Primary, secondary, and meta-analysis of research. Education Researcher, 1976, 5, 38.CrossRefGoogle Scholar
23.Glass, G. V. Integrating findings: The meta-analysis of research. In Shulman, L. S. (ed.), Review of research in education. Itasca, IL: Peacock Press, 1977.Google Scholar
24.Grotta, J. C.Current medical and surgical therapy for cerebrovascular disease. New England Journal of Medicine, 1987, 317, 1505–16.CrossRefGoogle ScholarPubMed
25.Hafner, C. D. & Evans, W. E.Carotid endarterectomy with local anesthesia: Results and advantages. Journal of Vascular Surgery, 1988, 7, 232–36.CrossRefGoogle ScholarPubMed
26.Hartmann, D. P.Considerations in the choice of interobserver reliability estimates. Journal of Applied Behavior, 1977, 11, 103–16.CrossRefGoogle Scholar
27.Hedges, L. & Olkin, I.Statistical methods for meta-analysis. Orlando, FL: Academic Press, 1985.Google Scholar
28.Hunter, J. E. & Schmidt, F. L.Methods of meta-analysis: Correcting error and bias in research findings. London: Sage Press, 1990.Google Scholar
29.Johnson, R. A. & Wichern, D. W.Applied multivariate statistical analysis. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1982.Google Scholar
30.Kempczinski, R. F., Brott, T. G., & Labutta, R. J.The influence of surgical specialty and caseload on the results of carotid endarterectomy. Journal of Vascular Surgery, 1986, 3, 911–16.CrossRefGoogle ScholarPubMed
31.Kistler, J. P. How can we prevent strokes? Harvard Medical School Health Letter, 08 1989, 12.Google Scholar
32.Kistler, J. P., Buonanno, F. S., & Gress, D. R.Carotid endarterectomy—specific therapy based on pathophysiology. New England Journal of Medicine, 1991, 325, 505–06.CrossRefGoogle ScholarPubMed
33.Klag, M. J., Whelton, R. K., & Seidler, A. J.Decline in U.S. stroke mortality: Demographic trends and antihypertensive treatment. Stroke, 1989, 20, 1421.CrossRefGoogle ScholarPubMed
34.Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E.An evaluation of outcome from intensive care in major medical centers. Annals of Internal Medicine, 1986, 104, 410–18.CrossRefGoogle ScholarPubMed
35.Kotila, M.Decline in the incidence of stroke. Stroke, 1988, 19, 1572–73.CrossRefGoogle ScholarPubMed
36.Krupski, W. C., Effeney, D. J., Goldstone, J., et al. Carotid endarterectomy in a metropolitan community: Comparison of results from three institutions. Surgery, 1985, 98, 492–99.Google Scholar
37.Leape, L. L., Park, R. E., Solomon, D. H., et al. Relation between surgeons’ practice volumes and geographic variation in the rate of carotid endarterectomy. New England Journal of Medicine, 1989, 321, 653–57.CrossRefGoogle ScholarPubMed
38.Levy, L. L.Carotid endarterectomy: When and why. Journal of the American Medical Association, 1991, 266, 3332–33.CrossRefGoogle Scholar
39.Light, R. J.Evaluation Studies Review Annual, vol. 8. Beverly Hills, CA: Sage Publications, 1983.Google Scholar
40.Light, R. J. & Pillemer, D. R.Summing up: The science of reviewing research. Cambridge, MA: Harvard University Press, 1984.CrossRefGoogle Scholar
41.Longnecker, M. P., Berlin, J. A., Orza, M. J., & Chalmers, T. C.A meta-analysis of alcohol consumption in relation to risk of breast cancer. Journal of the American Medical Association, 1988, 260, 652–56.CrossRefGoogle ScholarPubMed
42.Luft, H. S., Bunker, J. P., & Enthoven, A. C.Should operations be regionalized? The empirical relation between surgical volume and mortality. New England Journal of Medicine, 1979, 301, 1364–69.CrossRefGoogle ScholarPubMed
43.Luft, H. S., Hunt, S. S., & Maerki, S. C.The volume-outcome relationship: Practice makes perfect or selective referral patterns? Health Services Research, 1987, 22, 157–82.Google ScholarPubMed
44.Mayberg, M. R., Wilson, S. E., Yatsu, F., et al. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. Journal of the American Medical Association, 1991, 266, 3289–94.CrossRefGoogle ScholarPubMed
45.McCann, B. U.S. Health Care Financing Administration. Personal communication, 08 1987.Google Scholar
46.Merrick, N. J., Brook, R. H., Fink, A., & Solomon, D. H.Use of carotid endarterectomy in five California veterans administration medical centers. Journal of the American Medical Association, 1986, 256, 2631–35.Google ScholarPubMed
47.Merrick, N. J., Fink, A., Brook, R. H., et al. Indications for selected medical and surgical procedures—A literature review and ratings for appropriateness: Carotid endarterectomy. Publication R-3204/6CWF/HF/PMT/RWJ. Santa Monica, CA: Rand Corporation, 05 1986.Google Scholar
48.Merrick, N. J., Fink, A., Park, R. E., et al. Derivation of clinical indications for carotid endarterectomy by an expert panel. American Journal of Public Health, 1987, 78,187–90.CrossRefGoogle Scholar
49.National Center for Health Statistics. Detailed diagnoses and procedures for patients discharged from short-stay hospitals: United States, 1987. Vital and health statistics. Rockville, MD: U.S. Public Health Service. Personal communication, 1989.Google Scholar
50.North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. New England Journal of Medicine, 1991, 325, 445–52.CrossRefGoogle Scholar
51.Office of Assistant Secretary for Planning and Evaluation. A forward plan for Medicare coverage and technology assessment. Washington, DC: Office of the Secretary, U.S. Department of Health and Human Services, 1986.Google Scholar
52.Office of Research and Demonstrations. Geographic variations in commonly performed procedures under Medicare. Baltimore, MD: U.S. Health Care Financing Administration, 1990.Google Scholar
53.Office of Technology Assessment. Development of medical technology: Opportunities for Assessment. Washington, DC: U.S. Congress, 1976.Google Scholar
54.Office of Technology Assessment. Strategies for medical technology assessment. Washington, DC: U.S. Congress, 1982.Google Scholar
55.Office of Technology Assessment. Medical technology and the costs of the Medicare program. Washington, DC: U.S. Congress, 1984.Google Scholar
56.Ozminkowski, R. J., Wortman, P. M., & Roloff, D. W.Inborn/outborn status and neonatal survival: A meta-analysis of non-randomized studies. Statistics in Medicine, 1988, 7, 1207–21.CrossRefGoogle ScholarPubMed
57.Park, R. E., Fink, A., Brook, R. H., et al. Physician ratings of appropriate indications for six medical and surgical procedures. American Journal of Public Health, 1986, 76, 766–72.CrossRefGoogle ScholarPubMed
58.Pokras, R. Detailed diagnoses and procedures for patients discharged from short-stay hospitals: United States, 1985. Vital and health statistics. Number (PHS) 87–1751, Series 13, Number 90, Rockville, MD: National Center for Health Statistics, 1987.Google Scholar
59.Proceedings of the workshop on methodological issues in overviews of randomized controlled trials, May 1986. Statistics in Medicine, 1987, 6, 217410.Google Scholar
60.Roper, W. L., Winkenwerder, W., Hackbarth, G. M., & Krakauer, H.Effectiveness in health care: An initiative to evaluate and improve medical practice. New England Journal of Medicine, 1988, 319, 1193–202.CrossRefGoogle ScholarPubMed
61.Sacks, H. S., Berrier, J., Reitman, D., et al. Meta-analyses of randomized controlled trials. New England Journal of Medicine, 1987, 316, 450–55.CrossRefGoogle ScholarPubMed
62. Second International Study of Infarct Survival (“ISIS-2”) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction. Lancet, 1988, 349–60.CrossRefGoogle Scholar
63.Shadish, W. R., Cook, T. D., & Houts, A. C. Quasi-experimentation in a critical multiplist mode. In Trochim, W. M. K. (ed.), Advances in quasi-experimentation design and analysis. San Francisco, CA: Jossey-Bass, New Directions for Program Evaluation Series, vol. 31,1986.Google Scholar
64.Shaw, D. A., Venables, G. S., Cartlidge, N. E. D., et al. Carotid endarterectomy in patients with transient cerebral ischemia. Journal of Neurologic Sciences, 1984, 64, 4553.CrossRefGoogle Scholar
65.Slavin, R.Meta-analysis in education: How has it been used? Educational Researcher, 1984, 3, 615.CrossRefGoogle Scholar
66.Steinbrook, R. Heart surgery death rates found high in 1 in 6 hospitals. Los Angeles Times, Part 1, p. 3, 07 24, 1988.Google Scholar
67.Sundt, T. M.The ischemic tolerance of neural tissue and the need for monitoring and selective shunting during carotid endarterectomy. Stroke, 1983, 14, 9398.CrossRefGoogle ScholarPubMed
68.Sundt, T. M. Jr, Whisnant, J. P., Houser, O. W., & Fode, N. C. Prospective study of the effectiveness and durability of carotid endarterectomy. Mayo Clinic Proceedings, 1990, 65, 625–34.CrossRefGoogle ScholarPubMed
69.U.S. General Accounting Office. Cross design synthesis. A new strategy for medical effectiveness research, Report 92–18. Washington, DC: U.S. Government Printing Office, 1992.Google Scholar
70.Waldo, D. R., Sonnefeld, S. T., McKusick, D. R., & Arnett, R. H.Health expenditures by age group, 1977 and 1987. Health Care Financing Review, 1989, 10, 111–20.Google ScholarPubMed
71.Wiberg, J. & Nornes, H.Effects of carotid endarterectomy on blood flow in the internal carotid artery. Acta Neurochirurgica, 1983, 68, 217–26.CrossRefGoogle ScholarPubMed
72.Williams, S. V., Nash, D. B., & Goldfarb, N.Differences in mortality from coronary artery bypass graft surgery at five teaching hospitals. Journal of the American Medical Association, 1991, 266, 810–15.CrossRefGoogle ScholarPubMed
73.Winslow, C. M., Solomon, D. H., Chassin, M. R., et al. The appropriateness of carotid endarterectomy. New England Journal of Medicine, 1988, 318, 721–27.CrossRefGoogle ScholarPubMed
74.Wortman, P. M. & Yeaton, W. H. (eds.), Data synthesis: Methodologic and conceptual issues. San Francisco, CA: Jossey-Bass, New Directions for Program Evaluation Series, 1985.Google Scholar
75.Wortman, P. M. Judging research quality. In Cooper, D. H. & Hedges, L. (eds.), The hand book of research synthesis. In press.Google Scholar
76.Yeaton, W. H. & Sechrest, L.Critical dimensions in the choice and maintenance of successful treatments: Strength, integrity, and effectiveness. Journal of Consulting Clinical Psychology, 1981, 49, 156–67.CrossRefGoogle ScholarPubMed
77.Yeaton, W. H. & Sechrest, L. Estimating effect size. In Wortman, P. (ed.), Methods for evaluating health services. Beverly Hills, CA: Sage Research Progress Series in Evaluation, vol. 8, 1981.Google Scholar
78.Yeaton, W. H. & Wortman, P. M. (eds.). Issues in data synthesis. San Francisco, CA: Jossey-Bass, New Directions for Program Evaluation Series, 1984.Google Scholar
79.Yeaton, W. H. & Wortman, P. M.Using research synthesis in medical technology assessment. International Journal of Technology Assessment in Health Care, 1987, 3, 509–22.Google Scholar
80.Yeaton, W. H. & Wortman, P. M.Reconceptualizing reliability in meta-analytic reviews. Ann Arbor, MI: Institute for Social Research, 1992.Google Scholar
81.Yeaton, W. H., Kshirsagar, A., Langenbrunner, J. C., & Wortman, P. MUndertaking a quantitative synthesis of carotid endarterectomy: Methodologic issues. Ann Arbor, MI: Institute for Social Research, 1992.Google Scholar
82.Young, J. R., Humphries, A. W., Beven, E. G., & de Wolfe, V. G.Carotid endarterectomy without a shunt. Archives of Surgery, 1969, 99, 293–97.CrossRefGoogle ScholarPubMed
83.Yusuf, S., Peto, R., Lewis, J., et al. Beta-blockade during and after myocardial infarction: An overview of randomized trials. Progress in Cardiovascular Diseases, 1985, 27, 335–71.CrossRefGoogle ScholarPubMed
84.Zurbruegg, H. R., Seiler, R. W., Grolimund, P et al. , Morbidity and mortality of carotid endarterectomy: A literature review of the results reported in the last 10 years. Acta Neurochirurgica, 1987, 84, 312. CrossRefGoogle ScholarPubMed