108 Adverse Events After Carotid Endarterectomy: A National Surgical Quality Improvement Program Analysis. (August 2016) - Dasenbrock, Hormuzdiyar H.
Abstract : INTRODUCTION: The goal of this study was to create a predictive scale to risk stratify patients before carotid endarterectomy (CEA). METHODS: Patients who underwent carotid endarterectomy were extracted from the prospective National Surgical Quality Improvement Program registry targeted carotid files (2011-2013). Multivariable logistic regression evaluated predictors of an adverse event (30-day stroke, myocardial infarction, or death). Predictors screened included patient demographics, comorbidities, American Society of Anesthesiologists (ASA) class, preoperative laboratory values, ipsilateral and contralateral stenosis, symptomatic status, and preoperative medications. Independent predictors were utilized to build a predictive scale, which was validated using the 2014 National Surgical Quality Improvement Program (NSQIP) release. RESULTS: A total of 10 766 patients were included in the study population, in whom 2.8% developed an adverse event. Components of the NSQIP-CEA scale were: 2 points for age greater than 75 years, noninsulin diabetes mellitus, renal insufficiency, anemia, presentation with a transient ischemic attack, high-risk physiology, high-risk anatomy, no contralateral imaging; 3 points for insulin-dependent diabetes mellitus, contralateral severe stenosis, admission from the emergency department, ASA class 4 to 5 designation, and an emergent case; and 4 points for modified Rankin Scale >2 and presentation with a stroke. Greater NSQIP-CEA scale score was associated with increased odds of an adverse event in the study (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.11-1.16, P < .001, C: 0.67) and validation (OR, 1.13; 95% CI, 1.09-1.17, P < .001, C: 0.67) populations. Classification trees identified superior discrimination of the predictors in the study (C: 0.96) and validation (C: 0.99) populations compared with regression. Greater NSQIP-CEA score was predictive of death, stroke, myocardial infarction, any complication, reoperation, nonroutine discharge, and readmission in the study and validation populations ( P < .002). Patients with a NSQIP-CEA scale score greater than 12 points had a 30-day rate of adverse outcomes greater than 6%. CONCLUSION: The NSQIP-CEA scale predicts adverse outcomes after carotid endarterectomy.