Eddie Blay1, Yetunde Balogun2, Michael J Nooromid3, Mark K Eskandari3. 1. Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, Temple University Hospital, Philadelphia, PA. Electronic address: archimedes3t@gmail.com. 2. Department of Surgery, Temple University Hospital, Philadelphia, PA. 3. Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL.
Abstract
BACKGROUND: Recurrent ischemic events have been associated with delayed carotid endarterectomy (CEA) for patients who present with acute strokes. As such, earlier intervention has been advocated to preserve cerebral function and expedient rehabilitation. We sought to determine the differences in 30-day postoperative major adverse clinical events (MACEs) for patients who undergo early (≤7 days) and delayed (>7 days) CEA after acute stroke. METHODS: Our sample consisted of patients captured in the CEA-targeted American College of Surgeons National Surgical Quality Improvement Program data set between 2011 and 2015. The primary outcome was 30-day postoperative MACEs (death, stroke, or myocardial infarction [MI]). Differences in postoperative MACEs were determined between early and delayed CEA treatment. In addition, multivariable analyses were done to determine the association between various patient factors and postoperative complications after CEA for patients who presented with acute strokes. RESULTS: A total of 3,427 patients were identified who underwent CEA for acute stroke in the CEA-targeted files between 2011 and 2015. Overall, perioperative rates of 30-day death, stroke, or MI were 1.30% (n = 43), 2.74% (n = 94), and 0.96% (n = 33), respectively. There were no differences in 30-day postoperative death, stroke, or MI for early or delayed CEA after acute strokes. On multivariable analysis, independent predictors for postoperative MACEs in patients with acute stroke were age ≥80 years (OR 2.41; 95% CI [1.15-5.06]), preoperative beta-blocker use (OR 2.11; 95% CI [1.13-3.93]), and operative time > 150 min (OR 2.39; 95% CI [0.82-4.98]). CONCLUSIONS: There are no differences in postoperative 30-day death, stroke, or MI in early and delayed CEA after an acute stroke. These results substantiate the recommendation for early (<7 days) CEA after acute strokes.
BACKGROUND: Recurrent ischemic events have been associated with delayed carotid endarterectomy (CEA) for patients who present with acute strokes. As such, earlier intervention has been advocated to preserve cerebral function and expedient rehabilitation. We sought to determine the differences in 30-day postoperative major adverse clinical events (MACEs) for patients who undergo early (≤7 days) and delayed (>7 days) CEA after acute stroke. METHODS: Our sample consisted of patients captured in the CEA-targeted American College of Surgeons National Surgical Quality Improvement Program data set between 2011 and 2015. The primary outcome was 30-day postoperative MACEs (death, stroke, or myocardial infarction [MI]). Differences in postoperative MACEs were determined between early and delayed CEA treatment. In addition, multivariable analyses were done to determine the association between various patient factors and postoperative complications after CEA for patients who presented with acute strokes. RESULTS: A total of 3,427 patients were identified who underwent CEA for acute stroke in the CEA-targeted files between 2011 and 2015. Overall, perioperative rates of 30-day death, stroke, or MI were 1.30% (n = 43), 2.74% (n = 94), and 0.96% (n = 33), respectively. There were no differences in 30-day postoperative death, stroke, or MI for early or delayed CEA after acute strokes. On multivariable analysis, independent predictors for postoperative MACEs in patients with acute stroke were age ≥80 years (OR 2.41; 95% CI [1.15-5.06]), preoperative beta-blocker use (OR 2.11; 95% CI [1.13-3.93]), and operative time > 150 min (OR 2.39; 95% CI [0.82-4.98]). CONCLUSIONS: There are no differences in postoperative 30-day death, stroke, or MI in early and delayed CEA after an acute stroke. These results substantiate the recommendation for early (<7 days) CEA after acute strokes.
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