A widely used operation to prevent stroke by removing blockages from blood vessels in the neck is safe even for the elderly, and safest and least expensive when done in hospitals performing the greatest number, a Johns Hopkins study has found.
Researchers report that the most frequently performed vascular operation, carotid endarterectomy, is safe even for people in their 80s and 90s, although older individuals tended to have slightly longer patient stays and higher hospital charges associated with greater medical needs.
"This is extremely important information since the very elderly are at the greatest risk of stroke, and thus can benefit most from this stroke-preventing operation," says Bruce A. Perler, lead author of the study and a professor of surgery.
In CEA, physicians clear plaque from the inner lining of the carotid artery, the main artery supplying blood to the head and neck. Blocked carotid arteries are one of the most common causes of stroke.
Using the Maryland Health Services Cost Review Commission database, the researchers tracked 9,918 CEAs performed at 48 Maryland hospitals between 1990 and 1995. Patients ranged in age from 34 to 92. The mortality rate associated with the procedure was 0.9 percent and the stroke rate was only 1.7 percent, remarkably lower than reported in previous population-based studies, the researchers said.
In hospitals performing fewer than 10 CEAs per year, however, the death rate was 1.9 percent, compared to 0.8 percent in hospitals doing more than 50 per year. The rate of neurological complications following the surgeries also was much greater in the low-volume hospitals compared with the high-volume medical centers, 6.1 percent vs. 1.8 percent, respectively.
Results of the study were published in the January issue of
the Journal of Vascular Surgery.