OBJECTIVES: This study investigated the relationship between annual hospital volume and the outcomes in carotid endarterectomy and quantified critical volume threshold for this procedure. DATA SOURCES: PubMed, EMBASE and the Cochrane library were searched for all articles on the volume-outcome relationship in CEA. REVIEW METHODS: Articles were included if they presented data on post-operative mortality and/or stroke rates and annual hospital volume of CEA. The review conformed to the QUOROM statement. The data were meta-analysed and a pooled effect estimate of volume on the stroke and/or mortality rates from CEA quantified, along with the critical volume threshold. RESULTS: Twenty-five articles, encompassing 936 436 CEA, were analysed. Significant relationships between mortality rate and stroke rate and annual volume were seen. Overall, the pooled effect estimate was odds ratio 0.78 [95% confidence interval 0.64-0.92], in favour of surgery at higher volume units, with a critical volume threshold of 79 CEA per annum. CONCLUSIONS: Significantly lower mortality and stroke rates were achieved at hospitals providing a higher annual hospital volume of CEA. Hospitals wishing to provide CEA should adhere to minimum volume criteria.
OBJECTIVES: This study investigated the relationship between annual hospital volume and the outcomes in carotid endarterectomy and quantified critical volume threshold for this procedure. DATA SOURCES: PubMed, EMBASE and the Cochrane library were searched for all articles on the volume-outcome relationship in CEA. REVIEW METHODS: Articles were included if they presented data on post-operative mortality and/or stroke rates and annual hospital volume of CEA. The review conformed to the QUOROM statement. The data were meta-analysed and a pooled effect estimate of volume on the stroke and/or mortality rates from CEA quantified, along with the critical volume threshold. RESULTS: Twenty-five articles, encompassing 936 436 CEA, were analysed. Significant relationships between mortality rate and stroke rate and annual volume were seen. Overall, the pooled effect estimate was odds ratio 0.78 [95% confidence interval 0.64-0.92], in favour of surgery at higher volume units, with a critical volume threshold of 79 CEA per annum. CONCLUSIONS: Significantly lower mortality and stroke rates were achieved at hospitals providing a higher annual hospital volume of CEA. Hospitals wishing to provide CEA should adhere to minimum volume criteria.
Authors: Nicole R Gonzales; Bart M Demaerschalk; Jenifer H Voeks; MeeLee Tom; George Howard; Alice J Sheffet; Lawrence Garcia; Daniel G Clair; John Barr; Steven Orlow; Thomas G Brott Journal: Stroke Date: 2014-09-25 Impact factor: 7.914
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Authors: Jens Fiehler; Olav Jansen; Jürgen Berger; Hans-Henning Eckstein; Peter A Ringleb; Robert Stingele Journal: Neuroradiology Date: 2008-09-23 Impact factor: 2.804