Carotid endarterectomy in asymptomatic patients with limited life expectancy

Jessica B. Wallaert, Randall R De Martino, Samuel R G Finlayson, Daniel B. Walsh, Matthew A. Corriere, David H. Stone, Jack L. Cronenwett, Philip P. Goodney

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Background and Purpose: Data from randomized trials assert that asymptomatic patients undergoing carotid endarterectomy (CEA) must live 3 to 5 years to realize the benefit of surgery. We examined how commonly CEA is performed among asymptomatic patients with limited life expectancy. Methods: Within the American College of Surgeons National Quality Improvement Project we identified 8 conditions associated with limited life expectancy based on survival estimates using external sources. We then compared rates of 30-day stroke, death, and myocardial infarction after CEA between asymptomatic patients with and without life-limiting conditions. Results: Of 12 631 CEAs performed in asymptomatic patients, 2525 (20.0%) were in patients with life-limiting conditions or diagnoses. The most common conditions were severe chronic obstructive pulmonary disease and American Society of Anesthesiologists Class IV designation. Patients with life-limiting conditions had significantly higher rates of perioperative complications, including stroke (1.8% versus 0.9%, P<0.001), death (1.4% versus 0.3%, P<0.001), and stroke/death (2.9% versus 1.1%, P<0.001). Even after adjustment for other comorbidities, patients with life-limiting conditions were nearly 3 times more likely to experience perioperative stroke or death than those without these conditions (OR, 2.8; 95% CI, 2.1-3.8; P<0.001). Conclusion: CEA is performed commonly in asymptomatic patients with life-limiting conditions. Given the high rates of postoperative stroke/death in these patients as well as their limited life expectancy, the net benefit of CEA in this population remains uncertain. Health policy research examining the role of CEA in asymptomatic patients with life-limiting conditions is necessary and may serve as a potential source for significant healthcare savings in the future.

Original languageEnglish (US)
Pages (from-to)1781-1787
Number of pages7
JournalStroke
Volume43
Issue number7
DOIs
StatePublished - Jul 2012
Externally publishedYes

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Keywords

  • appropriate
  • asymptomatic
  • carotid endarterectomy
  • life expectancy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Wallaert, J. B., De Martino, R. R., Finlayson, S. R. G., Walsh, D. B., Corriere, M. A., Stone, D. H., Cronenwett, J. L., & Goodney, P. P. (2012). Carotid endarterectomy in asymptomatic patients with limited life expectancy. Stroke, 43(7), 1781-1787. https://doi.org/10.1161/STROKEAHA.112.650903