Association between operator specialty and outcomes after carotid artery revascularization
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".