| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Policy Analysis and Management (Dr. O’Neill), Cornell University, Ithaca, NY; the Department of Veterans Affairs Medical Center (Dr. Lanska), VA Great Lakes Healthcare System, Tomah; the Department of Neurology (Dr. Lanska), University of Wisconsin, Madison, WI; and the Department of Family Medicine (Dr. Hartz), University of Iowa, Iowa City.
Address correspondence and reprint requests to Dr. Liam O’Neill, N 229 MVR Hall, Cornell University, Ithaca, NY 14853-4401; e-mail: lo22{at}cornell.edu
PURPOSE: To identify surgeon characteristics associated with mortality or morbidity, following carotid endarterectomy (CEA).
METHODS: Data on all inpatient discharges from the 284 nonfederal Pennsylvania hospitals were obtained from the Pennsylvania Health Care Cost Containment Council for the period from 1994 to 1995. Physician data were obtained from the Physicians List of the American Medical Association, including name, gender, specialty, year of birth, board certified, and year of licensure. Cases were selected if any of six procedures codes were ICD-9-CM rubric 38.12, indicating CEA.
RESULTS: Among the 12,725 cases studied, in-hospital mortality was 0.7%, nonfatal morbidity was 3.0%, and the total bad outcome rate was 3.7%. Surgeons who performed 1 to 2 CEAs over 2 years had the highest mortality (2.0%) and total bad outcome (9.2%) rates. For surgeons performing three or more cases in 2 years, increased volume was not associated with better outcomes. A greater number of years since the surgeon was licensed was associated with greater mortality (p = 0.001), but not with morbidity or bad outcome rates. In regression analyses that adjusted for patient risk, both years since licensure and specialty predicted surgical mortality rate, but only volume predicted surgical bad outcome rate.
CONCLUSIONS: More years since licensure and very low patient volume are associated with worse patient outcomes following CEA.
This article has been cited by other articles:
|
|
 |
|
  P. Nordin and W. v. d. Linden Volume of procedures and risk of recurrence after repair of groin hernia: national register study BMJ, April 26, 2008; 336(7650): 934 - 937. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. K. Choudhry, R. H. Fletcher, and S. B. Soumerai Systematic Review: The Relationship between Clinical Experience and Quality of Health Care Ann Intern Med, February 15, 2005; 142(4): 260 - 273. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. L. Hoh, J. D. Rabinov, J. C. Pryor, B. S. Carter, and F. G. Barker II In-Hospital Morbidity and Mortality after Endovascular Treatment of Unruptured Intracranial Aneurysms in the United States, 1996-2000: Effect of Hospital and Physician Volume AJNR Am. J. Neuroradiol., August 1, 2003; 24(7): 1409 - 1420. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. E. Feasby, H. Quan, and W. A. Ghali Hospital and Surgeon Determinants of Carotid Endarterectomy Outcomes Arch Neurol, December 1, 2002; 59(12): 1877 - 1881. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Halm, C. Lee, and M. R. Chassin Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature Ann Intern Med, September 17, 2002; 137(6): 511 - 520. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. L. Hannan, A. J. Popp, P. Feustel, E. Halm, G. Bernardini, J. Waldman, D. Shah, and M. R. Chassin Association of Surgical Specialty and Processes of Care With Patient Outcomes for Carotid Endarterectomy Stroke, December 1, 2001; 32(12): 2890 - 2897. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Carotid Endarterectomy: The Debate Continues Journal Watch Neurology, December 7, 2000; 2000(1207): 2 - 2. [Full Text]
|
|
|
|
 |
|
 H. J. M. Barnett and J. P. Broderick Carotid endarterectomy: Another wake-up call Neurology, September 26, 2000; 55(6): 746 - 747. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
