This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Thomas S. Huber, MD, PhD; Paul W. Durance, PhD; Andris Kazmers, MD, MSPH; Lloyd A. Jacobs, MD

Arch Surg. 1997;132(10):1134-1139.

Abstract
Objective
To examine the effect of the Asymptomatic Carotid Atherosclerosis Study on the volume of carotid endarterectomies (CEAs) performed in Veterans Affairs medical centers.

Design
The data were retrospectively extracted from the Veterans Affairs Patient Treatment File for all patients undergoing CEA using the International Classification of Diseases, Ninth Revision, Clinical Modification procedural code 38.12. Data were classified into patient management categories to identify complications and to quantify the severity of illnesses and comorbidities.

Setting
All 172 US Veterans Affairs medical centers.

Patients
Veterans undergoing CEA during fiscal years 1993 through 1995.

Main Outcome Measures
Procedural volume, mortality, and morbidity.

Results
There was a 43.4% increase in the volume of CEAs performed in fiscal year 1995 despite a 4.6% decrease in the served inpatients and an 8.8% decrease in the inpatient surgical procedures. The monthly volume of CEAs increased (P<.001, r²=0.78) at the onset of the fiscal year (October 1994) immediately after the Asymptomatic Carotid Atherosclerosis Study clinical advisory. The volume of CEAs increased in every region of the country for all nonpsychiatric hospital classifications and for almost every surgeon subspecialty. Despite the increased volume, the operative mortality rate, the International Classification of Diseases, Ninth Revision, Clinical Modification–and patient management categories—based complication rates, and the patients' comorbidity and severity of illness indexes all remained unchanged.

Conclusion
The dramatic increase in CEAs following the Asymptomatic Carotid Atherosclerosis Study clinical advisory suggests that the conclusions of the trial have been accepted by the medical community throughout the Veterans Affairs medical centers.

Arch Surg. 1997;132:1134-1139

Author Affiliations
From the Department of Surgery, Gainesville Veterans Affairs Medical Center and the University of Florida College of Medicine, Gainesville (Dr Huber); Department of Veterans Affairs, Ann Arbor Health Services Research and Development (Drs Durance, Kazmers, and Jacobs), University of Michigan School of Public Health (Dr Durance), Ann Arbor, Mich; Department of Surgery, Wayne State University School of Medicine, Detroit, Mich (Dr Kazmers); and Departments of Surgery, University of Michigan Medical School and Ann Arbor Veterans Affairs Medical Center (Dr Jacobs).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Sex differences in carotid endarterectomy utilization and 30-day postoperative mortality
Sheikh and Bullock
Neurology 2003;60:471-476.
ABSTRACT | FULL TEXT  

Hospital and Surgeon Determinants of Carotid Endarterectomy Outcomes
Feasby et al.
Arch Neurol 2002;59:1877-1881.
ABSTRACT | FULL TEXT  

Geographic Variation in the Rate of Carotid Endarterectomy in Canada Editorial Comment
Feasby et al.
Stroke 2001;32:2417-2422.
ABSTRACT | FULL TEXT  

Relation Between Prepublication Release of Clinical Trial Results and the Practice of Carotid Endarterectomy
Gross et al.
JAMA 2000;284:2886-2893.
ABSTRACT | FULL TEXT  

Results of carotid endarterectomy with prospective neurologist follow-up
Chaturvedi et al.
Neurology 2000;55:769-772.
ABSTRACT | FULL TEXT  

Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy
O'Neill et al.
Neurology 2000;55:773-781.
ABSTRACT | FULL TEXT  

Carotid Endarterectomy : Where Do We Draw the Line?
Gorelick
Stroke 1999;30:1745-1750.
FULL TEXT  

Is Carotid Endarterectomy Appropriate for Asymptomatic Stenosis?: No
Chaturvedi
Arch Neurol 1999;56:879-881.
FULL TEXT  

Natural History of Asymptomatic Carotid Stenosis: When Should We Operate and Why?
Muluk
PERSPECT VASC SURG ENDOVASC THER 1999;12:15-26.
ABSTRACT  

Effect of the Asymptomatic Carotid Atherosclerosis Study on Carotid Endarterectomy in Florida
Huber et al.
Stroke 1998;29:1099-1105.
ABSTRACT | FULL TEXT