Variability in carotid endarterectomy at a single medical center: An outcome and cost analysis

Carotid endarterectomy (CEA) is a common surgical procedure. Its efficacy in the prevention of stroke has been proven by multiple clinical trials including North American Symptomatic Carotid Endarterectomy Trial and Asymptomatic Carotid Atherosclerosis Study. Currently, there is a wide variability in the technique of this operation. This study was performed to determine the variability of CEA at the University of Kentucky Medical Center with a focus on cost and short-term outcome. We reviewed the charts of a consecutive series of 349 patients undergoing CEA at our institution. We analyzed the variability in shunt used across surgeons, intraoperative variables, cost, and outcome. Data on 374 procedures on 349 patients who underwent CEA showed shunt utilization varied significantly by surgeon from 3 to 94%. Patch utilization also varied significantly by surgeon. Two in-hospital deaths occurred in the shunt group (1.3%) and none in the no-shunt group. Shunt placement was associated with 1 hour 24 minutes increase in operative time from 2 hours 3 minutes in the no-shunt group to 3 hours 27 minutes in the shunt group (t test, p<0.01). Shunt placement was associated with a 1.74-day increase in length of stay, from 2.97 days in the no-shunt group to 4.71 days in the shunt group. There was no significant difference in the cost of procedure in these two groups: no-shunt $11,510±$3,977, shunt group $11,479±$4,030. This study showed no significant difference in cost or outcome between various techniques.