Evaluation of Readmission Rates for Carotid Endarterectomy Versus Carotid Artery Stenting in the US Medicare Population

Abstract

Objective: We evaluated rates and identified predictors of readmission in the Medicare population after carotid endarterectomy (CEA) compared to carotid artery stenting (CAS). Methods: MedPAR data (2005-2009) were used to select patients who underwent CEA or CAS (utilizing International Classification of Diseases, Ninth Revision, Clinical Modification codes). Readmission was evaluated using chi-square and multivariable logistic regression. Results: A total of 235 247 carotid interventions were performed (211 118 CEA and 24 129 CAS). Readmission rates (%) for patients undergoing CEA and CAS, respectively, were 8.84 and 11.11 (30 days; P < .0001); 13.31 and 17.98 (60 days; P < .0001); and 16.86 and 22.68 (90 days; P < .0001). Patients aged >80 (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.20-1.30) and patients with renal failure (OR = 1.6 95%; CI = 1.56-1.73), congestive heart failure (OR = 1.6; 95%CI = 1.57-1.73), diabetes (OR = 1.4; 95% CI 1.27-1.52), and CAS (OR = 1.2; 95%CI = 1.15-1.25) were more likely to be readmitted. Conclusions: Interventions for carotid artery disease had high overall readmission rates. After adjustment for comorbidities, utilization of less invasive techniques (CAS) did not result in lower readmission rates. Further evaluation is needed to determine strategies to reduce hospital readmission rates after carotid interventions.