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To assess the outcome of carotid endarterectomy in England with respect to the hospital
Data were from English Hospital Episode Statistics (2000-2005). Admissions were classified
as elective or emergency. Risk-adjusted data were analysed through modelling of death
rate, complication rate and length of admission with regard to the year of procedure
and annual hospital volume of surgery. Hospitals with elevated death rates were identified
and the evidence quantified that they had outlying mortality rates.
There were 280,081 diagnoses of extra-cranial atherosclerotic arterial disease in
which 18,248 CEA were performed. The mean mortality rates were 1.04% for elective
and 3.16% for emergency CEA. A volume-related improvement in mortality (p=0.047) was
seen for elective CEA. Length of stay decreased as annual volume increased for elective
and emergency CEA (p<0.001). 20% of the operations were performed in 67.1% of the
hospitals, each of which performed fewer than 10 CEA per annum. A number of hospitals
had elevated death rates.
Volume-related improvements in outcome were demonstrated for elective CEA. Minimum
volume-criteria of 35 CEA per annum should be established in England. Hospitals performing
low annual volumes of surgery should consider arrangements to network services.