Association of Centre Quality Certification with Characteristics of Patients, Management, and Outcomes Following Carotid Endarterectomy or Carotid Artery Stenting

Author:

Saicic Stefan1,Knappich Christoph1ORCID,Kallmayer Michael1,Kirchhoff Felix1ORCID,Bohmann Bianca1,Lohe Vanessa1,Naher Shamsun1,Böhm Julian2,Lückerath Sofie1,Eckstein Hans-Henning1,Kuehnl Andreas1ORCID

Affiliation:

1. Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University of Munich, 81675 Munich, Germany

2. Landesarbeitsgemeinschaft zur Datengestützten, Einrichtungsübergreifenden Qualitätssicherung in Bayern (LAG Bayern), 80331 Munich, Germany

Abstract

Background: The aim of this study was to analyze the association between center quality certifications and patients’ characteristics, clinical management, and outcomes after carotid revascularization. Methods: This study is a pre-planned sub-study of the ISAR-IQ project, which analyzes data from the Bavarian subset of the nationwide German statutory quality assurance carotid database. Hospitals were classified as to whether a certified vascular center (cVC) or a certified stroke unit (cSU) was present on-site or not. The primary outcome event was any stroke or death until discharge from the hospital. Results: In total, 31,793 cases were included between 2012 and 2018. The primary outcome rate in asymptomatic patients treated by CEA ranged from 0.7% to 1.5%, with the highest rate in hospitals with cVC but without cSU. The multivariable regression analysis revealed a significantly lower primary outcome rate in centers with cSU in asymptomatic patients (aOR 0.69; 95% CI 0.56–0.86; p < 0.001). In symptomatic patients needing emergency treatment, the on-site availability of a cSU was associated with a significantly lower primary outcome rate (aOR 0.56; 95% CI 0.40–0.80; p < 0.001), whereas the presence of a cVC was associated with higher risk (aOR 3.07; 95% CI 1.65–5.72). Conclusions: This study provides evidence of statistically significant better results in some sub-cohorts in certified centers. In centers with cSU, the risk of any stroke or death was significantly lower in asymptomatic patients receiving CEA or symptomatic patients treated by emergency CEA.

Funder

Germany’s Federal Joint Committee Innovation Fund

Publisher

MDPI AG

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