CEA and CAS Readmissions Compared in Medicare Population

 

April 6, 2015—In appropriately selected patients with severe carotid stenosis, carotid revascularization has been shown to reduce ischemic stroke. Previous clinical research has focused on the efficacy and safety of carotid revascularization, and few investigators have considered readmission as a clinically important outcome.

With this background, investigators conducted a study that aimed to examine the frequency and timing of 30-day readmission after carotid revascularization, assess the differences in 30-day readmission between patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS), describe hospital variation in risk-standardized readmission rates (RSRRs), and examine whether hospital variation in the choice of procedure (CEA vs CAS) is associated with differences in RSRRs.

The investigators found that approximately 10% of Medicare patients undergoing carotid revascularization were readmitted within 30 days of discharge. Compared with CEA, CAS was associated with a greater occurrence of readmission. However, hospitals’ RSRRs did not differ by their proportional use of CAS.

Mohammed Salim Al-Damluji, MD, et al published these findings in the Journal of American College of Cardiology (JACC; 2015;65:1398–1408). 

As summarized in JACC, the investigators used Medicare fee-for-service administrative claims data to identify acute care hospitalizations for CEA and CAS from 2009 to 2011. They calculated crude 30-day all-cause hospital readmissions following carotid revascularization. Kaplan-Meier survival curves and fitted mixed-effects logistic regression were used to assess differences in readmissions after CAS compared with CEA. Hospital RSRRs were estimated using hierarchical generalized logistic regression. The investigators stratified hospitals into five groups by their proportional CAS use and compared hospital group median RSRRs.

Of the 180,059 revascularizations at 2,287 hospitals, CEA and CAS were performed in 81.5% and 18.5% of cases, respectively. The unadjusted 30-day readmission rate following carotid revascularization was 9.6%. The readmission risk after CAS was greater than that after CEA. There was modest hospital-level variation in 30-day RSRRs. Variation in the proportional use of CAS was not associated with differences in hospital RSRRs, reported the investigators in JACC.

 

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