Hospital mortality rate on average is 20% higher in non-trial hospitals. 60% of hospitals perform fewer than 17 CEA per year. 88% of surgeons perform at.

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Presentation transcript:

Hospital mortality rate on average is 20% higher in non-trial hospitals. 60% of hospitals perform fewer than 17 CEA per year. 88% of surgeons perform at or below median value of 21 CEA per year. Stroke morbidity is 7.7% in hospitals performing CEA at numbers in the lowest quartile vs 2.5% for the highest quartile (p< 0.03). CEA results are clearly better in high volume institutions / surgeons.

Carotid Endarterectomy 1971 to 1999 (Rates per Thousand) ,000 CEA performed in U.S CEA most common vascular operation > 1 million worldwide and Rand data - “substantially overused” 1988-present - complex, randomized, multi-center controlled clinical efficacy trials

First carotid reconstruction for stroke prevention First CEA using techniques similar to ,000 CEA performed in U.S CEA became firmly established as the most common peripheral vascular operation with over 1 million performed worldwide and Rand Corp data - CEA “substantially overused”

Carotid Endarterectomy 1971 to 1998 (Rates per Thousand) Year

CEA Cases/Quarter/100,000 State of Florida ACAS Advisory

Florida CEA Procedures as Percent of 1992-Q1 Adjusted for Age

1988-present -- an unprecedented series of complex, randomized, multi-center controlled clinical efficacy trials have been initiated and completed. NASCET (1991, 1998) ECST (1991, 1996) VA Cooperative Studies Program (1991) CASANOVA (1991) VA Cooperative Study Group (1993) ACAS (1995) ACST (ongoing)

Trials for symptomatic and asymptomatic stenosis %