Association between operator specialty and outcomes after carotid artery revascularization
Notice bibliographique
Résumé
OBJECTIVE: To examine the association between operator specialty and 30-day outcomes among patients undergoing carotid endarterectomy and carotid artery stenting. METHODS: We conducted a population-based, observational cohort study of all individuals who underwent carotid endarterectomy or stenting in Ontario, Canada (population, 13.6 million) between April 1, 2002, and March 1, 2015, using administrative claims databases. We stratified endarterectomy and stenting patients according to operator specialty, and followed them for 30 days after the procedure. For carotid endarterectomy, we compared outcomes between vascular surgeons and nonvascular surgeons. For carotid artery stenting, we compared outcomes between radiologists and neurosurgeons. We built multilevel multivariable logistic regression models adjusted for patient demographics, comorbidities, carotid artery symptom status, and annual institutional and operator volume to examine rates of 30-day stroke or death. RESULTS: A total of 16,544 patients were studied (n = 14,301 endarterectomy and n = 2243 stenting). Vascular surgeons performed the majority (55.7%) of carotid endarterectomy procedures, followed by neurosurgeons (21.0%), general surgeons (15.3%), and cardiac surgeons (7.9%). Radiologists (82.5%) and neurosurgeons (17.5%) performed carotid artery stenting. In the endarterectomy group, the risk of stroke or death was higher among patients treated by nonvascular surgeons (4.0%) compared with vascular surgeons (2.9%; adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.08-1.62; P = .008). This difference was driven by a higher rate of stroke among nonvascular surgery-treated patients (3.6%) compared with vascular surgery-treated patients (2.5%; adjusted OR, 1.38; 95% CI, 1.11-1.71). The risk of death was similar between the two groups. With respect to specific nonvascular surgery specialties, the rate of 30-day stroke or death was higher in endarterectomy patients treated by neurosurgeons (4.1%; adjusted OR, 1.27; 95% CI, 1.00-1.61) and cardiac surgeons (4.4%; adjusted OR, 1.54; 95% CI, 1.04-2.30) compared with vascular surgeons (2.9%). Patients who underwent carotid artery stenting by radiologists vs neurosurgeons experienced 30-day stroke or death at similar rates (8.0% vs 7.9%, respectively; adjusted OR, 1.07; 95% CI, 0.66-1.74; P = .79). CONCLUSIONS: The risk for periprocedural stroke or death was significantly higher among carotid endarterectomy patients treated by nonvascular surgeons (neurosurgeons and cardiac surgeons) compared with vascular surgeons. Operator specialty did not seem to have a significant effect on periprocedural outcomes among patients who underwent carotid artery stenting. These results can have implications for physician referral practices and local policies.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».