Author + information
- Received August 31, 2014
- Revision received January 14, 2015
- Accepted January 28, 2015
- Published online May 1, 2015.
- Beau M. Hawkins, MD∗,
- Kevin F. Kennedy, MS†,
- Herbert D. Aronow, MD, MPH‡,
- Louis L. Nguyen, MD, MBA, MPH§,
- Christopher J. White, MD‖,
- Kenneth Rosenfield, MD¶,
- Sharon-Lise T. Normand, PhD#,
- John A. Spertus, MD, MPH† and
- Robert W. Yeh, MD, MSc¶∗ ()
- ∗Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- †Saint Luke’s Mid-America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
- ‡St. Joseph Mercy Hospital–Michigan Heart Division, Ann Arbor, Michigan
- §Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ‖John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana
- ¶Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- #Department of Health Care Policy (Biostatistics), Harvard Medical School, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Robert W. Yeh, Cardiology Division, GRB 8-843, Massachusetts General Hospital, Boston, Massachusetts 02114.
Objectives The aim of this study was to examine variation in outcomes for patients receiving carotid artery stenting (CAS) across a sample of U.S. hospitals and assess the extent to which this variation was attributable to differences in case mix and procedural volume.
Background As CAS is increasingly being used throughout the United States, assessing hospital variation in CAS outcomes is critical to understanding and improving the quality of care for patients with carotid artery disease.
Methods Hospitals participating in the National Cardiovascular Data Registry–Carotid Artery Endarterectomy and Revascularization Registry contributing more than 5 CAS procedures from 2005 through 2013 were eligible for inclusion. We estimated unadjusted and risk-standardized rates of in-hospital stroke or death for each participating hospital using a previously validated prediction model and applying hospital-level random effects.
Results There were 188 hospitals contributing 19,381 CAS procedures during the period of interest. Unadjusted and risk-standardized in-hospital stroke or death rates ranged from 0% to 18.8% and 1.2% to 4.7%, respectively. Operator and hospital volumes were not significant predictors of outcomes after adjustment for case mix (p = 0.15 and p = 0.09, respectively).
Conclusions CAS outcomes vary 4-fold among hospitals, even after adjustment for differences in case mix. Future work is needed to identify the sources of this variation and develop initiatives to improve patient outcomes.
This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR). The views expressed in this manuscript represent those of the author(s) and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com. The CARE Registry is an initiative of the American College of Cardiology Foundation, The Society for Cardiovascular Angiography and Interventions, the Society of Interventional Radiology, the American Academy of Neurology, the American Association of Neurological Surgeons/Congress of Neurological Surgeons, the Society for Vascular Medicine, and the Society of Vascular and Interventional Neurology. Dr. Aronow is a nonpaid consultant for Silk Road Medical, Inc. Dr. Rosenfield has received research grants from Abbott Vascular, Bard Peripheral Vascular, Medtronic/Invatec, and Atrium; has received consulting/advisory board fees from Abbott Vascular, Boston Scientific, Complete Conference Management, Harvard Clinical Research Institute, Contego, Micell, and Becker Ventures; has equity in Lumen Biomedical, Medical Stimulation Corp, Angioguard (Cordis), and Micell; and has served on the Board of Directors of VIVA Physicians (501C3). Dr. Normand is on the Board of Directors of Frontier Science Technology and Research Foundation. Dr. Spertus has received a research contract from the American College of Cardiology Foundation to analyze the NCDR Registry. Dr. Yeh is an investigator at the Harvard Clinical Research Institute. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 31, 2014.
- Revision received January 14, 2015.
- Accepted January 28, 2015.
- 2015 American College of Cardiology Foundation