Racial variations in postoperative outcomes of carotid endarterectomy: evidence from the Veterans Affairs National Surgical Quality Improvement Program.
CONTEXT: Black patients and Hispanic patients receive carotid endarterectomy (CEA) at lower rates than white patients. It is unclear whether worse surgical outcomes are influencing clinical decision-making regarding use of the operation among minority group patients. OBJECTIVE: To determine if there are racial differences in postoperative outcomes for patients undergoing CEA at Veterans Affairs (VA) medical centers. DESIGN: Secondary analysis of data from an ongoing, prospective study on surgical quality and outcomes in the VA health care system. SETTING: One hundred thirty-two VA Medical Centers that were part of the VA National Surgical Quality Improvement Program. PATIENTS: A cohort of 6551 men (91.4% white, 5.3% black, and 3.3% Hispanic) who had CEA performed between October 1, 1994 and September 30, 1997. MAIN OUTCOME MEASURES: Primary outcomes were stroke or death and stroke, myocardial infarction (MI), or death within 30 days of the operation. RESULTS: Thirty-day postoperative rates of stroke or death and of stroke, MI, or death were generally low for all racial/ethnic groups, ranging between 2.6% and 6.5%. Within clinical states that define indications for CEA, rates were also low (1.6% to 3.2%) among asymptomatic patients across racial/ethnic groups. However, among patients with transient ischemic attack (TIA), Hispanic patients had significantly worse outcomes than white patients with a postoperative rate of stroke or death of 10.5% (P < 0.05) and stroke, MI, or death of 13.2% (P < 0.05) compared with 3.1% to 3.5% for white patients. Hispanic patients did not differ from black patients for stroke, death/stroke, death, or MI. CONCLUSION: Rates of major postoperative complications after CEA are low within the VA and similar across racial/ethnic groups with the possible exception of Hispanic men with TIA. Further investigation of this elevated complication rate among Hispanic men with TIA may be warranted.
Horner, RD; Oddone, EZ; Stechuchak, KM; Grambow, SC; Gray, J; Khuri, SF; Henderson, WG; Daley, J
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