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Robert G. Holloway, Jr, MD, MPH; David M. Witter, Jr, MA; Alvin I. Mushlin, MD, ScM; Kirke B. Lawton, MA; Michael P. McDermott, PhD; Greg P. Samsa, PhD

Arch Neurol. 1998;55:25-32.

Objective  To evaluate whether the patterns of inpatient care and patient characteristics have changed for patients undergoing a carotid endarterectomy across a group of academic medical centers from 1990 through 1995. If changes occurred, we investigated whether they had an impact on patient outcomes.

Design  Retrospective evaluation of patients undergoing a carotid endarterectomy using a hospital discharge data set compiled by the Academic Medical Center Consortium.

Setting  Ten academic medical centers.

Patients  A total of 7019 hospital admissions for patients who had 1 carotid endarterectomy performed as a principal procedure from January 1990 to December 1995.

Main Outcome Measures  Trends in patient demographics, comorbidities, length of stay, days in the intensive care unit, and inpatient cerebral arteriogram use were determined. Patient outcomes included inpatient mortality, discharge to an institution, 30-day readmission rate, and selected diagnoses (postoperative hemorrhage, infection, or seizure; acute myocardial infarction; or cranial nerve palsy) and postprocedure diagnostic tests (computed tomography and magnetic resonance imaging of the head and electroencephalogram) indicative of complications.

Results  Over the 6-year study period, the number of carotid endarterectomies performed more than doubled and the percentage of hospital admissions for patients 65 years or older increased from 65% to 75%. The mean and median length of stay halved and the percentage of admissions with transfers to the intensive care unit decreased from 56% to 26% of cases. In addition, the percentage of cases with a cerebral arteriogram during the same admission but prior to the day of the carotid endarterectomy decreased from 52% to 27%. There were no trends in inpatient mortality, discharge to an institution, or 30-day readmission rate. There were no significant trends indicative of poorer quality of care as measured by the frequency of secondary diagnoses or postprocedure diagnostic test use.

Conclusions  Despite dramatic changes that have occurred in patient characteristics and in hospital management practices for patients undergoing a carotid endarterectomy from 1990 to 1995, we were unable to detect any measurable impact on patient outcomes. These data have implications for monitoring and evaluating the impact of systemwide change on the overall quality of care for patients undergoing a carotid endarterectomy.

From the Departments of Neurology (Dr Holloway), Community and Preventive Medicine (Drs Holloway and Mushlin and Mr Witter), and Biostatistics (Dr McDermott), University of Rochester School of Medicine and Dentistry, Rochester, NY; Association of American Medical Colleges, Washington, DC (Messrs Witter and Lawton); and the Departments of Medicine and Community and Family Medicine and Center for Health Policy Research and Education, Duke University, Durham, NC (Dr Samsa).

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