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Outcomes/Effectiveness Research

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Minor complications, common after carotid endarterectomy, are associated with higher postoperative risk of death and stroke

Most studies of carotid endarterectomy (CEA; surgery to prevent stroke by removing atherosclerotic plaque from the carotid artery in the neck) have focused on the major complications of death and stroke. Less is known about the frequency or clinical significance of minor surgical complications such as hematoma (bleeding inside the surgical repair site), cranial nerve (CN) palsy (numbness of the face, inability to swallow, or other type of paralysis due to cranial nerve injury), and wound infection.

Researchers from the Mount Sinai School of Medicine in New York report that these minor complications of CEA are common, occurring in 1 in 10 cases, and are associated with three- to four-fold greater odds of postoperative death or stroke and longer hospital stays. Using clinically detailed, population-based data from the New York Carotid Artery Surgery Study on 9,308 CEAs performed by 482 surgeons in 167 hospitals, they examined associations between minor (cranial nerve palsies, hematoma, and wound infection) and major complications (death and stroke) within 30 days of surgery.

Overall, 10 percent of patients suffered a minor surgical complication (cranial nerve palsy, 5.5 percent; hematoma, 5 percent; and wound infection, 0.2 percent). About 3.9 percent of patients endured cardiac complications, such as myocardial infarction, unstable angina, or ventricular tachycardia.

The occurrence of any minor surgical complication, cranial nerve palsy alone, or hematoma alone was associated with three- to four-fold greater odds of postoperative stroke or combined risk of death and nonfatal stroke. Patients with cardiac complications had four- to five-fold increased odds of stroke or combined risk of death and stroke.

Because they are more common, tracking minor complications (along with major ones) might be a useful strategy for measuring and improving the quality of surgical care. The study was supported in part by the Agency for Healthcare Research and Quality (HS09754).

See "Association between minor and major surgical complications after carotid endarterectomy: Results of the New York Carotid Artery Surgery Study," by Alexander J. Greenstein, M.D., Mark R. Chassin, M.D., M.P.P., M.P.H., Jason Wang, Ph.D., and others in the December 2007 Journal of Vascular Surgery 46(6), pp. 1138-1146.

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