Carotid endarterectomy in a metropolitan community: comparison of results from three institutions.

ABSTRACT

The hospitalizations of 300 patients who had carotid endarterectomies (CEA) in three different kinds of hospital were analyzed. 100 patients had CEA performed by experienced vascular surgeons in a university hospital (UH), 100 patients had CEA performed by experienced vascular surgeons in private community hospitals (PCH), and 100 patients had CEA performed by senior general surgery residents (GSR) assisted by experienced vascular surgeons in a university-affiliated Veterans Administration hospital (VA). Analysis of patient characteristics revealed that, compared with the other groups, VA patients were (1) younger (62 +/- 7 years; p less than 0.001); (2) had a higher frequency of peripheral vascular operations (51%; p less than 0.01; (3) were more often cigarette smokers (84%; p less than 0.001); and (4) had more contralateral carotid occlusions (19%) and ulcerated lesions (73%) (p less than 0.01). GSR had longer operating room times and cerebral ischemia times during shunt insertion and removal (6 +/- 2.8 minutes) and during the CEA (30 +/- 27 minutes) (p less than 0.001). Postoperative hypertension and neck hematomas were less common in PCH patients (p less than 0.001) than in the other groups. Although their duration of hospitalization (17 +/- 12 days) was longer, the VA patients experienced no increased morbidity. There was a high rate of cranial nerve injury in all groups (27%, 15%, 17%) but symptoms were not often permanent (9%, 6%, 6%). Our data indicate that results of vascular operations performed by well-supervised residents are comparable in all important respects to those performed by fully trained surgeons.