目的:本研究旨在根据分流术评估颈动脉内膜切除术(CEA)后的住院结局,尤其是对侧颈动脉闭塞(CCO)或近期卒中患者。分析了2012年至2020年在血管质量倡议数据库中注册的CEA的数据,不包括数据库中注册的CEA<10的外科医生,伴随程序,重新干预,和不完整的数据。
方法:根据其分流使用率,参与的外科医生分为三组:非分流者(<5%),选择性分流(5-95%),和常规分流(>95%)。医院中风的主要结果,死亡,并分析了有症状和无症状患者的卒中和死亡率(SDR)。
结果:共有113202名患者符合研究标准,其中31147例为有症状,82055例为无症状。包括1645名外科医生,12.1%是非分流者,63.6%是选择性分流者,24.3%是常规分流者,每组有10557、71160和31579个程序,分别。在单变量分析中,医院中风(2.0%vs.1.9%与1.6%;p=.17),死亡(0.5%与0.4%与0.4%;p=.71),和特别提款权(2.2%与2.1%与1.8%;p=0.23)在症状队列中三组之间没有统计学差异。无症状队列在住院卒中也没有显示出统计学上的显着差异(0.9%与1.0%与0.9%;p=.55),死亡(0.2%vs.0.2%与0.2%;p=.64),和特别提款权(1.0%与1.1%与1.0%;p=.43)。多变量模型在三个分流队列之间的主要结局没有统计学上的显着差异。关于子群分析,CCO患者的SDR无统计学差异(3.3%与2.5%与2.4%;p=.64)和最近中风的人(2.9%与3.4%与3.1%;p=.60)。
结论:在医院SDR的三种分流策略之间没有发现统计学上的显着差异,包括患有CCO或近期中风的患者。
OBJECTIVE: This study aimed to evaluate in hospital outcomes after carotid endarterectomy (CEA) according to shunt usage, particularly in patients with contralateral carotid occlusion (CCO) or recent stroke. Data from CEAs registered in the Vascular Quality Initiative database between 2012 and 2020 were analysed, excluding surgeons with < 10 CEAs registered in the database, concomitant procedures, re-interventions, and incomplete data.
METHODS: Based on their rate of shunt use, participating surgeons were divided in three groups: non-shunters (< 5%), selective shunters (5 - 95%), and routine shunters (> 95%). Primary outcomes of in hospital stroke, death, and stroke and death rate (SDR) were analysed in symptomatic and asymptomatic patients.
RESULTS: A total of 113 202 patients met the study criteria, of whom 31 147 were symptomatic and 82 055 were asymptomatic. Of the 1 645 surgeons included, 12.1% were non-shunters, 63.6% were selective shunters, and 24.3% were routine shunters, with 10 557, 71 160, and 31 579 procedures in each group, respectively. In the univariable analysis, in hospital stroke (2.0% vs. 1.9% vs. 1.6%; p = .17), death (0.5% vs. 0.4% vs. 0.4%; p = .71), and SDR (2.2% vs. 2.1% vs. 1.8%; p = .23) were not statistically significantly different among the three groups in the symptomatic cohort. The asymptomatic cohort also did not show a statistically significant difference for in hospital stroke (0.9% vs. 1.0% vs. 0.9%; p = .55), death (0.2% vs. 0.2% vs. 0.2%; p = .64), and SDR (1.0% vs. 1.1% vs. 1.0%; p = .43). The multivariate model did not show a statistically significant difference for the primary outcomes between the three shunting cohorts. On subgroup analysis, the SDRs were not statistically significantly different for patients with CCO (3.3% vs. 2.5% vs. 2.4%; p = .64) and those presenting with a recent stroke (2.9% vs. 3.4% vs. 3.1%; p = .60).
CONCLUSIONS: No statistically significant differences were found between three shunting strategies for in hospital SDR, including in patients with CCO or recent stroke.