Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics

Article Abstract:

Mortality rates following carotid endarterectomy (CEA) may be much higher in routine practice than the rates seen in two clinical trials of CEA. The NASCET trial achieved a post-operative death rate of 0.6% and that in the ACAS trial was 0.1%. Researchers analyzed post-operative death rates in 113,300 Medicare patients who had CEA. Some had the procedure in the same hospitals that participated in the trials. The overall mortality rate was 1.4% in the trial hospitals and from 1.7% to 2.5% in non-trial hospitals, depending on how many CEAs the surgeons performed. Hospitals that performed fewer CEAs had higher mortality rates.

Complications and side effects, Surgery, Postoperative complications, Endarterectomy, Carotid artery, Carotid arteries

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High-Risk Surgery--Follow the Crowd

Article Abstract:

Many lives might be saved if people scheduled for certain types of elective surgery have the operation at a hospital with experience in that type of surgery. These hospitals are often called high-volume hospitals because they treat large numbers of patients who require that type of surgery. A study in California found that 500 deaths could have been prevented if patients having 10 specific types of surgery had the surgery at a high-volume hospital instead of a low-volume hospital. Most patients would not have to travel more than 25 miles to get to a high-volume hospital.

Editorial, Prevention, Death, Surgery, Elective, Elective surgery

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Surgical mortality as an indicator of hospital quality: the problem with small sample size

Article Abstract:

Surgical mortality rates are increasingly used to measure hospital quality however it is not clear how many hospitals have sufficient caseloads to reliably identify quality problems. The result show that except for coronary artery bypass graft (CABG) surgery, the operations for which surgical mortality is advocated as a quality indicator are not performed frequently enough to judge hospital quality.

Influence, Hospital services, Surgical errors

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