Annals of vascular surgery · 2026
Relationship between Annual Hospital Volume and Outcome Following Carotid Endarterectomy for Symptomatic Carotid Stenosis in Sweden.
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Öjersjö Andreas, Pärsson Håkan, Johansson Håkan, Jonsson Magnus
Аннотация
BACKGROUND: In several European countries, declining volumes of surgery for symptomatic carotid stenosis have been reported, likely as a consequence of reduced smoking rates and improved medical therapy. In Sweden, 21 centers are performing carotid endarterectomy (CEA), 5 of them performing nearly 50% of the total volume. The aim of the present study was to compare outcomes after CEA in high-volume and low-volume centers and to see whether there is an optimal volume threshold.
METHODS: This registry-based study included all patients treated with CEA (n = 12,169) for symptomatic carotid stenosis during the period July 2008-December 31, 2023. All centers were analyzed separately and also dichotomized if performing more than 50 CEAs annually (high-volume centers) or less than 50 procedures (low-volume centers). Multivariable logistic regression models were used to assess independent predictors of ipsilateral and contralateral stroke, while Cox proportional hazards models were used for death and stroke or death outcomes, accounting for patient-level covariates and center effects. Sensitivity analyses were performed by exclusion of smallest centers, alternative thresholds, and stratification for early and late study periods.
RESULTS: In the crude analysis, stroke or death was more frequent in the low volume group, occurring in 4.48% of cases (95% confidence interval [CI] 3.98-5.03) compared to 3.62% (95% CI 3.17-4.13) in the high-volume group (P = 0.018). After adjusting for differences in comorbidities and demographic data, low-volume centers demonstrated significantly higher odds of stroke or death within 30 days after CEA, with a hazard ratio of 1.23 (95% CI: 1.03-1.47, P = 0.023) CONCLUSION: There is an inverse relationship between hospital volume and the rate of stroke or death following carotid endarterectomy in Sweden. Reorganization of carotid surgery services should be considered.
METHODS: This registry-based study included all patients treated with CEA (n = 12,169) for symptomatic carotid stenosis during the period July 2008-December 31, 2023. All centers were analyzed separately and also dichotomized if performing more than 50 CEAs annually (high-volume centers) or less than 50 procedures (low-volume centers). Multivariable logistic regression models were used to assess independent predictors of ipsilateral and contralateral stroke, while Cox proportional hazards models were used for death and stroke or death outcomes, accounting for patient-level covariates and center effects. Sensitivity analyses were performed by exclusion of smallest centers, alternative thresholds, and stratification for early and late study periods.
RESULTS: In the crude analysis, stroke or death was more frequent in the low volume group, occurring in 4.48% of cases (95% confidence interval [CI] 3.98-5.03) compared to 3.62% (95% CI 3.17-4.13) in the high-volume group (P = 0.018). After adjusting for differences in comorbidities and demographic data, low-volume centers demonstrated significantly higher odds of stroke or death within 30 days after CEA, with a hazard ratio of 1.23 (95% CI: 1.03-1.47, P = 0.023) CONCLUSION: There is an inverse relationship between hospital volume and the rate of stroke or death following carotid endarterectomy in Sweden. Reorganization of carotid surgery services should be considered.