Association between minor and major surgical complications after carotid endarterectomy

Results of the New York Carotid Artery Surgery study

Alexander J. Greenstein, Mark R. Chassin, Jason Wang, Caron B. Rockman, Thomas S. Riles, Stanley Tuhrim, Ethan A. Halm

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective: Most studies on outcomes of carotid endarterectomy (CEA) have focused on the major complications of death and stroke. Less is known about minor but more common surgical complications such as hematoma, cranial nerve palsy, and wound infection. This study used data from a large, population-based cohort study to describe the incidence of minor surgical complications after CEA and examine associations between minor and major complications. Methods: The New York Carotid Artery Surgery (NYCAS) study examined all Medicare beneficiaries who underwent CEA from January 1998 to June 1999 in NY State. Detailed clinical information on preoperative characteristics and complications ≤30 days of surgery was abstracted from hospital charts. Associations between minor (cranial nerve palsies, hematoma, and wound infection) and major complications (death/stroke) were examined with χ2 tests and multivariate logistic regression. Results: The NYCAS study had data on 9308 CEAs performed by 482 surgeons in 167 hospitals. Overall, 10% of patients had a minor surgical complication (cranial nerve (CN) palsy, 5.5%; hematoma, 5.0%; and wound infection, 0.2%). Cardiac complications occurred in 3.9% (myocardial 1.1%, unstable angina 0.9%, pulmonary edema 2.1%, and ventricular tachycardia 0.8%). In both unadjusted and adjusted analyses, the occurrence of any minor surgical complication, CN palsy alone, or hematoma alone was associated with 3 to 4-fold greater odds of perioperative stroke or combined risk of death and nonfatal stroke (P < 0.0001). Patients with cardiac complications had 4 to 5-fold increased odds of stroke or combined risk of death and stroke. Conclusion: Minor surgical complications are common after CEA and are associated with much higher risk of death and stroke. Patient factors, process factors, and direct causality are involved in this relationship, but future work will be needed to better understand their relative contributions.

Original languageEnglish (US)
Pages (from-to)1138-1146
Number of pages9
JournalJournal of Vascular Surgery
Volume46
Issue number6
DOIs
StatePublished - Dec 2007

Fingerprint

Carotid Endarterectomy
Carotid Arteries
Stroke
Cranial Nerve Diseases
Hematoma
Wound Infection
Unstable Angina
Pulmonary Edema
Ventricular Tachycardia
Medicare
Ambulatory Surgical Procedures
Causality
Cohort Studies
Logistic Models
Outcome Assessment (Health Care)
Incidence
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Association between minor and major surgical complications after carotid endarterectomy : Results of the New York Carotid Artery Surgery study. / Greenstein, Alexander J.; Chassin, Mark R.; Wang, Jason; Rockman, Caron B.; Riles, Thomas S.; Tuhrim, Stanley; Halm, Ethan A.

In: Journal of Vascular Surgery, Vol. 46, No. 6, 12.2007, p. 1138-1146.

Research output: Contribution to journalArticle

Greenstein, Alexander J. ; Chassin, Mark R. ; Wang, Jason ; Rockman, Caron B. ; Riles, Thomas S. ; Tuhrim, Stanley ; Halm, Ethan A. / Association between minor and major surgical complications after carotid endarterectomy : Results of the New York Carotid Artery Surgery study. In: Journal of Vascular Surgery. 2007 ; Vol. 46, No. 6. pp. 1138-1146.
@article{cfd45471ac9d462e852e6a75ddefa70f,
title = "Association between minor and major surgical complications after carotid endarterectomy: Results of the New York Carotid Artery Surgery study",
abstract = "Objective: Most studies on outcomes of carotid endarterectomy (CEA) have focused on the major complications of death and stroke. Less is known about minor but more common surgical complications such as hematoma, cranial nerve palsy, and wound infection. This study used data from a large, population-based cohort study to describe the incidence of minor surgical complications after CEA and examine associations between minor and major complications. Methods: The New York Carotid Artery Surgery (NYCAS) study examined all Medicare beneficiaries who underwent CEA from January 1998 to June 1999 in NY State. Detailed clinical information on preoperative characteristics and complications ≤30 days of surgery was abstracted from hospital charts. Associations between minor (cranial nerve palsies, hematoma, and wound infection) and major complications (death/stroke) were examined with χ2 tests and multivariate logistic regression. Results: The NYCAS study had data on 9308 CEAs performed by 482 surgeons in 167 hospitals. Overall, 10{\%} of patients had a minor surgical complication (cranial nerve (CN) palsy, 5.5{\%}; hematoma, 5.0{\%}; and wound infection, 0.2{\%}). Cardiac complications occurred in 3.9{\%} (myocardial 1.1{\%}, unstable angina 0.9{\%}, pulmonary edema 2.1{\%}, and ventricular tachycardia 0.8{\%}). In both unadjusted and adjusted analyses, the occurrence of any minor surgical complication, CN palsy alone, or hematoma alone was associated with 3 to 4-fold greater odds of perioperative stroke or combined risk of death and nonfatal stroke (P < 0.0001). Patients with cardiac complications had 4 to 5-fold increased odds of stroke or combined risk of death and stroke. Conclusion: Minor surgical complications are common after CEA and are associated with much higher risk of death and stroke. Patient factors, process factors, and direct causality are involved in this relationship, but future work will be needed to better understand their relative contributions.",
author = "Greenstein, {Alexander J.} and Chassin, {Mark R.} and Jason Wang and Rockman, {Caron B.} and Riles, {Thomas S.} and Stanley Tuhrim and Halm, {Ethan A.}",
year = "2007",
month = "12",
doi = "10.1016/j.jvs.2007.08.026",
language = "English (US)",
volume = "46",
pages = "1138--1146",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Association between minor and major surgical complications after carotid endarterectomy

T2 - Results of the New York Carotid Artery Surgery study

AU - Greenstein, Alexander J.

AU - Chassin, Mark R.

AU - Wang, Jason

AU - Rockman, Caron B.

AU - Riles, Thomas S.

AU - Tuhrim, Stanley

AU - Halm, Ethan A.

PY - 2007/12

Y1 - 2007/12

N2 - Objective: Most studies on outcomes of carotid endarterectomy (CEA) have focused on the major complications of death and stroke. Less is known about minor but more common surgical complications such as hematoma, cranial nerve palsy, and wound infection. This study used data from a large, population-based cohort study to describe the incidence of minor surgical complications after CEA and examine associations between minor and major complications. Methods: The New York Carotid Artery Surgery (NYCAS) study examined all Medicare beneficiaries who underwent CEA from January 1998 to June 1999 in NY State. Detailed clinical information on preoperative characteristics and complications ≤30 days of surgery was abstracted from hospital charts. Associations between minor (cranial nerve palsies, hematoma, and wound infection) and major complications (death/stroke) were examined with χ2 tests and multivariate logistic regression. Results: The NYCAS study had data on 9308 CEAs performed by 482 surgeons in 167 hospitals. Overall, 10% of patients had a minor surgical complication (cranial nerve (CN) palsy, 5.5%; hematoma, 5.0%; and wound infection, 0.2%). Cardiac complications occurred in 3.9% (myocardial 1.1%, unstable angina 0.9%, pulmonary edema 2.1%, and ventricular tachycardia 0.8%). In both unadjusted and adjusted analyses, the occurrence of any minor surgical complication, CN palsy alone, or hematoma alone was associated with 3 to 4-fold greater odds of perioperative stroke or combined risk of death and nonfatal stroke (P < 0.0001). Patients with cardiac complications had 4 to 5-fold increased odds of stroke or combined risk of death and stroke. Conclusion: Minor surgical complications are common after CEA and are associated with much higher risk of death and stroke. Patient factors, process factors, and direct causality are involved in this relationship, but future work will be needed to better understand their relative contributions.

AB - Objective: Most studies on outcomes of carotid endarterectomy (CEA) have focused on the major complications of death and stroke. Less is known about minor but more common surgical complications such as hematoma, cranial nerve palsy, and wound infection. This study used data from a large, population-based cohort study to describe the incidence of minor surgical complications after CEA and examine associations between minor and major complications. Methods: The New York Carotid Artery Surgery (NYCAS) study examined all Medicare beneficiaries who underwent CEA from January 1998 to June 1999 in NY State. Detailed clinical information on preoperative characteristics and complications ≤30 days of surgery was abstracted from hospital charts. Associations between minor (cranial nerve palsies, hematoma, and wound infection) and major complications (death/stroke) were examined with χ2 tests and multivariate logistic regression. Results: The NYCAS study had data on 9308 CEAs performed by 482 surgeons in 167 hospitals. Overall, 10% of patients had a minor surgical complication (cranial nerve (CN) palsy, 5.5%; hematoma, 5.0%; and wound infection, 0.2%). Cardiac complications occurred in 3.9% (myocardial 1.1%, unstable angina 0.9%, pulmonary edema 2.1%, and ventricular tachycardia 0.8%). In both unadjusted and adjusted analyses, the occurrence of any minor surgical complication, CN palsy alone, or hematoma alone was associated with 3 to 4-fold greater odds of perioperative stroke or combined risk of death and nonfatal stroke (P < 0.0001). Patients with cardiac complications had 4 to 5-fold increased odds of stroke or combined risk of death and stroke. Conclusion: Minor surgical complications are common after CEA and are associated with much higher risk of death and stroke. Patient factors, process factors, and direct causality are involved in this relationship, but future work will be needed to better understand their relative contributions.

UR - http://www.scopus.com/inward/record.url?scp=37249041025&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=37249041025&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2007.08.026

DO - 10.1016/j.jvs.2007.08.026

M3 - Article

VL - 46

SP - 1138

EP - 1146

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 6

ER -