Vascular Surgeon Type Significantly Improves Carotid Endarterectomy and Carotid Artery Stenting Outcomes

Surgeon-specific variables including surgeon volume, surgeon experience, institutional volume, have been linked to outcomes after complex vascular surgery. Postoperative outcomes for carotid endarterectomy (CEA) have also shown differences between surgeon types in postoperative stroke and secondary outcomes, but no differences in mortality. In contrast, postoperative rates of stroke and death after carotid artery stenting (CAS) have not differed between vascular and nonvascular surgeons. Regardless, a paucity of data remains regarding surgeon type and carotid intervention outcomes. We hypothesize that the vascular surgeon phenotype will result in more favorable postoperative outcomes for CEA and CAS than nonvascular surgeons. The American College of Surgeons National Surgical Quality Improvement Project between 2005 and 2017 was queried using Current Procedural Terminology codes indicating CEA and CAS procedures and postoperative diagnosis codes were used to identify procedures conducted for carotid artery stenosis. In analysis by surgeon type, univariate analysis was conducted for baseline characteristics, operative variables, and multivariate logistic regression was used to analyze postoperative complications. This analysis was adjusted for baseline characteristics including age, race, American Society of Anesthesiologists score, and comorbidities. There were 100,151 CEA and CAS procedures identified. Vascular surgeons performed 93.4% of CEA/CAS procedures. Cardiovascular, thoracic, general, and neurologic surgeons comprised the majority of the nonvascular surgeons performing these procedures. Patients varied significantly in age, race, and in rates of comorbid hypertension and dyspnea based on treating surgeon (Table I). Vascular surgeons had higher rates of regional anesthesia use and lower rates of outpatient setting use (Table II). Importantly, vascular surgeon type in CEA/CAS was significantly associated with decreased stroke (odds ratio, 0.79; 95% confidence interval, 0.67-0.94; P < .008). Odds ratios of 30-day readmission, pulmonary complications, and septic shock were also -significantly lower in procedures performed by vascular surgeons (Table III). In our large sample, national database study, we found that vascular surgeon-performed CEA/CAS procedures resulted in beneficial outcomes in respect to postoperative stroke, readmission, pulmonary complications and septic shock. Further study is required to delineate this importance relative to other surgeon specific variables.Table IBaseline characteristics for patients undergoing carotid endarterectomy (CEA)/carotid artery stenting (CAS)Overall (n = 100,151)Nonvascular (n = 6,640)Vascular (n = 93,511)P valueAge (years)71.0 (9.3)70.7 (9.4)71.0 (9.3).01Female (%)39.939.939.9.98Patient race (%) American Indian/AK native0.30.80.348 hours)0.710.55-0.93.014Renal insufficiency0.590.33-1.04.070Renal failure1.010.51-1.98.987UTI0.780.61-1.02.067Stroke/CVA0.790.67-0.94.008MI1.270.95-1.69.108Bleeding complication0.900.74-1.11.335DVT0.860.50-1.49.593Sepsis0.910.54-1.55.748Septic shock0.440.23-0.84.013CI, Confidence interval; CVA, cerebrovascular accident; DVT, deep vein thrombosis; MI, myocardial infarction; OR, odds ratio; UTI, Urinary tract infection.Boldface entries indicate statistical significance. Open table in a new tab