E. Kenning1, C. Hollenbeak1,2, D. Han1,3 1Penn State Hershey Medical Center,Department Of Surgery,Hershey, PA, USA 2Penn State Hershey Medical Center,Division Of Outcomes Research And Quality,Hershey, PA, USA 3Penn State Hershey Medical Center,Heart And Vascular Institute, Division Of Vascular Surgery,Hershey, PA, USA
Introduction: Carotid artery stenosis is a premorbid condition that can precipitate devastating neurologic outcomes without intervention. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are two proven means of intervening on this disease process. In a health care milieu in which 30-day unplanned readmissions portend a negative financial impact for hospitals, it is necessary to understand rates and risk factors for readmission following these procedures. We hypothesized that no difference in readmission rates within 30 days would exist for these two procedures, in spite of differences that might exist between the two patient populations.
Methods: Using the Pennsylvania Health Care Cost Containment Council (PHC4) database, we identified 4,319 people who underwent CEA (N=3,640) or CAS (N=679) in Pennsylvania in 2011. Univariate analyses were performed to compare patient characteristics and outcomes between patients who underwent CEA and those who underwent CAS. Logistic regression was used to estimate the effect of intervention on 30-day readmission, after controlling for potential confounders. Time to readmission was analyzed using the Kaplan-Meier method.
Results: Patients who underwent CEA and CAS were similar with a few exceptions, including age, race, admission type, and comorbid conditions such as CHF, hemiplegia and paraplegia, and renal disease. The unadjusted rate of 30-day readmission was 9.37% for CEA and 10.75% for CAS (p=0.26). After controlling for patient and procedure characteristics, differences between 30-day readmission rates were still not statistically significant (odds ratio=1.13; p=0.39). Finally, time to readmission was similar for those who underwent CEA and those who underwent CAS (p=0.19) (Figure).
Conclusion: Readmission rates following CEA and CAS for carotid artery stenosis are approximately 10%. There are few differences between patients with carotid stenosis who are selected for endarterectomy and stenting, and the choice of procedure does not appear to be associated with different readmission rates or time to readmission, even after controlling for patient characteristics.
