Is the Eversion Technique Associated with Lower Peri-operative Stroke or Death Compared with Carotid Endarterectomy with Patch Angioplasty? Secondary Data Analysis of the German Statutory Quality Assurance Database.

Abstract

Various studies have failed to detect a difference in outcomes between carotid endarterectomy (CEA) with patch angioplasty and eversion CEA. This study aimed to assess whether surgical technique and related department policy are associated with in hospital outcomes after CEA. This was a secondary data analysis based on the German statutory quality assurance database. According to surgical technique policy, hospitals were categorised as routine eversion (> 90%), selective eversion (10 - 90%), or sporadic eversion (< 10%) centres. The primary outcome event (POE) was in hospital stroke or death. Uni- and multivariable regression analyses were performed. A total of 119 800 patients underwent CEA between 2012 and 2016. Multivariable regression analysis showed the eversion technique to be associated with a lower POE rate (adjusted odds ratio 0.78, 95% confidence interval 0.69 - 0.88). Routine eversion centres showed statistically significantly lower in hospital stroke or death rates compared with selective eversion and sporadic eversion centres (1.7% vs. 1.9% vs. 2.0%; p = .004). After risk adjustment, centre surgical technique policy did not show a significant association with any of the assessed outcomes. Eversion CEA compared with CEA with patch angioplasty was independently associated with a lower in hospital stroke or death rate. The centre policy with respect to surgical technique did not show an association with the primary or either of the secondary outcomes.