scholarly journals Stroke After Protected versus Unprotected Carotid Artery Stenting: An analysis of the National Surgical Quality Improvement Program

Author(s):  
Pouya Nazari
Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mohammed K Alhaidar ◽  
Richard Amdur ◽  
Rami Algahtani ◽  
Dimitri Sigounas ◽  
Mohanad Algaeed ◽  
...  

Background: Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS) are both viable treatment options for carotid artery stenosis. Factors including surgical risk, age, and symptomatic status are often used to help guide management decisions. Methods: We conducted a retrospective observational study using the National Surgical Quality Improvement Program (NSQIP) database to compare 30-day post-procedure outcomes including mortality, stroke, and myocardial infarction in patient with carotid stenosis undergoing CEA (n=54,640) versus CAS (n=488) from 2005 to 2012. Procedure type was identified by CPT codes. Findings: Patients undergoing CEA were more likely to be older and have symptomatic stenosis, and less likely to be white, have CHF, and have COPD. There was no significant difference between CEA and CAS in 30-day mortality (0.9% vs. 1.2%, p=0.33), stroke (1.6% vs. 1.6% p=0.93), myocardial infarction (0.9% vs. 1.6%, p=0.08), or combined outcome (3.0% vs. 4.9%, p=0.09). The interaction between symptomatic status and procedure type was not significant (p=0.29), indicating the association of symptomatic status with 30-day mortality was similar in cases receiving CEA and CAS. Conclusion: Early outcomes after CEA and CAS for carotid artery stenosis appear to be similar in a ‘real-world’ sample and comparable to clinical trials. Patients undergoing CAS were more likely to be younger and surgically higher risk based on baseline characteristics likely reflecting clinical practice case selection.


Author(s):  
George A. Beyer ◽  
Karan Dua ◽  
Neil V. Shah ◽  
Joseph P. Scollan ◽  
Jared M. Newman ◽  
...  

Abstract Introduction We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.


Sign in / Sign up

Export Citation Format

Share Document