Objective: The benefit of carotid endarterectomy is highly dependent on surgical risk. The aim of this study was to evaluate the incidence of stroke and death after carotid endarterectomy, risk factors for poor outcomes, and importance of surgeon's competence.
Material and methods: A total of 790 carotid endarterectomies performed in the Vilnius University Emergency Hospital between 1995 and 2006 were analyzed. Risk factors, neurological symptoms, comorbidities, radiologic and angiographic findings, morbidity and mortality, experience and volume of a vascular surgeon were prospectively recorded in a database. Univariate and multivariable logistic regression and receiver operating characteristic curves were used to analyze the data.
Results: Among the 790 cases studied, in-hospital mortality was 2.2%, and stroke morbidity was 2.4%. Postoperative complications were more common in patients with diabetes mellitus than without (12% vs. 3.4%, P<0.001) and in patients with any stroke than in patients with nonspecific symptoms (10.7% vs. 1.4%, P<0.02). The postoperative stroke rate was 10% for a surgeon who performed <6 carotid endarterectomies per year and 4.6% for a surgeon who performed ≥6 carotid endarterectomies (P=0.02). In the multivariate logistic regression, combined mortality and stroke was independently predicted by diabetes mellitus (OR, 3.51; 95% CI, 1.60-7.66; P=0.002), any stroke (OR, 4.14; 95% CI, 1.57-10.91; P=0.004), and low-volume surgeon (OR, 0.32; 95% CI, 0.13-0.78; P=0.013). The receiver operating characteristic curve analysis showed an overall predicting value of 0.72.
Conclusions: Diabetes mellitus, any stroke, and low-volume vascular surgeon were significant predictors for poor outcome after carotid endarterectomy.