Introduction: The increasing prevalence and earlier onset of risk factors has resulted in an expanding population of younger patients undergoing carotid endarterectomy (CEA) in recent times. Outcomes after CEA are largely unreported in these patients. In this study, we evaluate 30-day postoperative outcomes after CEA in an exclusive cohort of young and middle aged patients.
Methods: We studied all patients aged 64 years and younger, who underwent CEA in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from January 2005 to December, 2013. Univariate methods (Chi Square, ttest) were employed to compare patients’ characteristics. Multivariate regression adjusting for patient characteristics was used to identify predictors of adverse outcomes.
Results: There were 15830 CEA’s performed in this cohort with a mean age of 58 (S.D:5.1) years. The majority of patients were male (59%), Caucasian (85%) and hypertensive (81%). Nearly half (46%) were symptomatic. Overall, 266 (1.7%) patients suffered stroke in the 30 day post-operative period, while mortality and myocardial infarction rates were 0.6% and 0.4% respectively. The significant predictors of stroke or death were female gender (OR: 1.49; 95%CI: 1.15-1.92; p=0.002), symptomatic status (OR: 1.69; 95%CI: 1.30-2.21; p<0.001), previous cardiac intervention (OR: 1.42; 95%CI: 1.04-1.93; p=0.026) and physical dependence (OR: 1.81; 95%CI: 1.16-2.82; p=0.01). The mean length of in-hospital stay was 3 (SD:5.6) days and complications within 30 days of surgery are shown in Table 1.
Conclusions: Absolute stroke and mortality rates after CEA in young and middle aged patients are not different from those reported in the general population. Stroke and mortality are significantly higher in symptomatic, physically dependent patients and those with prior cardiac intervention. We recommend extra vigilance in the management of these patients in order to improve CEA outcomes.