Abstract WMP41: Risk of 1 Month Stroke, Adverse Events and Mortality following Carotid Endarterectomy (CEA) According to Body Mass Index, Analysis of National Surgical Quality Improvement Program (NSQIP) Registry

Background: Carotid revascularization procedures are infrequently performed in patients with mild-moderate thrombocytopenia. However, whether such procedures are associated with a higher unknown risk of peri-procedural complications such as myocardial infarction (MI)/arrhythmia, need for blood transfusions, unplanned intubations, and death. There is no large population based study available to quantify the risk after carotid endarterectomy (CEA) in patients with thrombocytopenia. Methods: We studied all patients who underwent CEA in the American College of Surgeons (ACS) National Surgical Quality Improvement Program(NSQIP) Registry between years 2011 and 2013.The ACS-NSQIP prospectively collects data on over 300 variables pertaining to patient characteristics, comorbid conditions, operative details, and 30-day post-operative outcomes. Thrombocytopenia was defined based on the pre procedure platelet count of <150,000 platelet/μL. The odds ratios for selected outcomes were calculated after adjusting for age, gender, and symptomatic status using logistic regression. Results: Thrombocytopenia was present in 931(10.5%) of 8835 patients who underwent CEA. Their severity of thrombocytopenia was mild (100,000-149,000 platelets/μL) and moderate (<100,000platelets/μL) in 821(88.18%) and 110(11.8%) patients, respectively. Patients with thrombocytopenia were more likely to be asymptomatic prior to CEA (54.4% vs. 45.6%; p=0.02). There was a significantly higher prevalence of MI/arrhythmia among patients with thrombocytopenia in compare to without (3.7% vs. 1.8%; odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.33-2.88; p<0.001). The incidence of unplanned intubation post CEA was higher among patients with thrombocytopenia (2.5% vs. 1.2%; p=0.004). There were no differences in the need for blood transfusions (2.5% vs. 2.4%; OR: 1.05; 95% CI: 0.67-1.64; p =0.83) and one month mortality (0.6% vs. 0.8%; OR: 0.66; 95% CI: 0.28-1.54; p=0.33) among patients with and without thrombocytopenia. Conclusions: The higher rate of post procedural complications in patients with thrombocytopenia needs to be recognized for appropriate risk stratification.

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PC052. Contemporary American College of Surgeons National Surgical Quality Improvement Program Outcomes of Carotid Endarterectomy in Patients With Moderate and Severe Chronic Kidney Disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.04.319 ◽

2019 ◽

Vol 69 (6) ◽

pp. e217-e219

Author(s):

Shelley Maithel ◽

Nii-Kabu Kabutey ◽

Jeffrey J. Siracuse ◽

Brian M. Sheehan ◽

Carlos E. Donayre ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Quality Improvement ◽

Kidney Disease ◽

Carotid Endarterectomy ◽

Quality Improvement Program ◽

Program Outcomes ◽

Improvement Program ◽

Surgical Quality ◽

American College Of Surgeons ◽

Severe Chronic Kidney Disease

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Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

PLoS ONE ◽

10.1371/journal.pone.0146254 ◽

2016 ◽

Vol 11 (1) ◽

pp. e0146254 ◽

Cited By ~ 31

Author(s):

Joshua Montroy ◽

Rodney H. Breau ◽

Sonya Cnossen ◽

Kelsey Witiuk ◽

Andrew Binette ◽

...

Keyword(s):

Systematic Review ◽

Quality Improvement ◽

Adverse Events ◽

Meta Analysis ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality

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Outcomes after carotid endarterectomy: Is there a high-risk population? A National Surgical Quality Improvement Program report

Journal of Vascular Surgery ◽

10.1016/j.jvs.2008.09.018 ◽

2009 ◽

Vol 49 (2) ◽

pp. 331-339.e1 ◽

Cited By ~ 43

Author(s):

Jeanwan L. Kang ◽

Thomas K. Chung ◽

Robert T. Lancaster ◽

Glenn M. LaMuraglia ◽

Mark F. Conrad ◽

...

Keyword(s):

Quality Improvement ◽

High Risk ◽

Carotid Endarterectomy ◽

Quality Improvement Program ◽

High Risk Population ◽

Improvement Program ◽

Surgical Quality ◽

Risk Population

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Delayed Ileal Pouch Anal Anastomosis Has a Lower 30-Day Adverse Event Rate: Analysis From the National Surgical Quality Improvement Program

Inflammatory Bowel Diseases ◽

10.1093/ibd/izy082 ◽

2018 ◽

Vol 24 (8) ◽

pp. 1833-1839 ◽

Cited By ~ 4

Author(s):

Bharati Kochar ◽

Edward L Barnes ◽

Anne F Peery ◽

Katherine S Cools ◽

Joseph Galanko ◽

...

Keyword(s):

Adverse Event ◽

Quality Improvement ◽

Adverse Events ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Quality Improvement Program ◽

Adverse Event Rate ◽

Improvement Program ◽

Surgical Quality ◽

Anal Anastomosis

Abstract Background Ulcerative colitis (UC) patients requiring colectomy often have a staged ileal pouch anal anastomosis (IPAA). There are no prospective data comparing timing of pouch creation. We aimed to compare 30-day adverse event rates for pouch creation at the time of colectomy (PTC) with delayed pouch creation (DPC). Methods Using prospectively collected data from 2011–2015 through the National Surgical Quality Improvement Program, we conducted a cohort study including subjects aged ≥18 years with a postoperative diagnosis of UC. We assessed 30-day postoperative rates of unplanned readmissions, reoperations, and major and minor adverse events (AEs), comparing the stage of the surgery where the pouch creation took place. Using a modified Poisson regression model, we estimated risk ratios (RRs) with 95% confidence intervals (CIs) adjusting for age, sex, race, body mass index, smoking status, diabetes, albumin, and comorbidities. Results Of 2390 IPAA procedures, 1571 were PTC and 819 were DPC. In the PTC group, 51% were on chronic immunosuppression preoperatively, compared with 15% in the DPC group (P < 0.01). After controlling for confounders, patients who had DPC were significantly less likely to have unplanned reoperations (RR, 0.42; 95% CI, 0.24–0.75), major AEs (RR, 0.72; 95% CI, 0.52–0.99), and minor AEs (RR, 0.48; 95% CI, 0.32–0.73) than PTC. Conclusions Patients undergoing delayed pouch creation were at lower risk for unplanned reoperations and major and minor adverse events compared with patients undergoing pouch creation at the time of colectomy.

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Carotid endarterectomy under local and/or regional anesthesia has less risk of myocardial infarction compared to general anesthesia: An analysis of national surgical quality improvement program database

Vascular ◽

10.1177/1708538114537489 ◽

2014 ◽

Vol 23 (2) ◽

pp. 113-119 ◽

Cited By ~ 20

Author(s):

Elias Kfoury ◽

Jonathan Dort ◽

Amber Trickey ◽

Moira Crosby ◽

Jean Donovan ◽

...

Keyword(s):

Myocardial Infarction ◽

Quality Improvement ◽

General Anesthesia ◽

Carotid Endarterectomy ◽

Regional Anesthesia ◽

Artery Bypass ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality ◽

Postoperative Myocardial Infarction

Multiple studies have evaluated the effect of anesthesia type on carotid endarterectomy with inconsistent results. Our study compared 30-day postoperative myocardial infarction, stroke, and mortality between carotid endarterectomy under local or regional anesthesia and carotid endarterectomy under general anesthesia utilizing National Surgical Quality Improvement Program database. All patients listed in National Surgical Quality Improvement Program database that underwent carotid endarterectomy under general anesthesia and local or regional anesthesia from 2005 to 2011 were included with the exception of patients undergoing simultaneous carotid endarterectomy and coronary artery bypass grafting. The data revealed substantial differences between the two groups compared, and these were adjusted using multiple logistic regression. Postoperative myocardial infarction, stroke, and death at 30 days were compared between the two groups. A total of 42,265 carotid endarterectomy cases were included. A total of 37,502 (88.7%) were performed under general anesthesia and 4763 (11.3%) under local or regional anesthesia. Carotid endarterectomy under local or regional anesthesia had a significantly decreased risk of 30-day postoperative myocardial infarction when compared to carotid endarterectomy under general anesthesia (0.4% vs 0.86%, p = 0.012). No statistically significant differences were found in postoperative stroke or mortality. Carotid endarterectomy under local or regional anesthesia carries a decreased risk of postoperative myocardial infarction when compared to carotid endarterectomy under general anesthesia. Therefore, patients at risk of postoperative myocardial infarction undergoing carotid endarterectomy, consideration of local or regional anesthesia may reduce that risk.

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