Thirty-Day Readmissions After Carotid Artery Stenting Versus Endarterectomy: Analysis of the 2013–2014 Nationwide Readmissions Database

• Published in: Circulation. Cardiovascular interventions Vol. 13; no. 4; p. e008508
• Main Authors: Lima, Fabio V., Kolte, Dhaval, Kennedy, Kevin F., Wang, Lily J., Abbott, J. Dawn, Soukas, Peter A., Aronow, Herbert D.
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01-04-2020
• Subjects: carotid artery stenting; length of stay; carotid endarterectomy; transient ischemic attack; propensity score
• ISSN: 1941-7632; 1941-7640; 1941-7632
• DOI: 10.1161/CIRCINTERVENTIONS.119.008508

Contemporary, nationally representative 30-day readmissions data after carotid artery stenting (CAS) and carotid endarterectomy (CEA) are lacking.
Patients undergoing CAS or CEA were identified from the 2013 to 2014 Nationwide Readmissions Databases. Propensity matching was used to balance baseline clinical characteristics. Thirty-day nonelective readmission rates, length of stay, and causes of readmission were compared.
Overall, 85 337 (national estimate of 194 332) patients were identified before propensity score matching, 11 490 (13.4%) of whom underwent CAS and 73 847 (86.6%) of whom underwent CEA. Crude 30-day readmission rates were higher for patients treated with CAS than CEA (8.3% versus 6.8%;
<0.001), but these differences were negated in the propensity-matched cohort (n=22 214; 8.4% versus 7.9%,
=0.20), and readmission length of stay was longer for CEA than CAS (2 versus 1 day, respectively;
=0.002). The most common reasons for readmission were neurological and cardiac events; readmission reasons varied by revascularization modality. Readmission due to a stroke or transient ischemic attack was more common among patients treated with CAS than CEA (1.2% versus 0.9%;
=0.042), while readmission for procedural or medical complications occurred more often following CEA than CAS (1.1% versus 0.5%;
<0.001); readmission rates for cardiac causes were similar between groups.
Less than 8% of patients are readmitted within 30 days of a carotid revascularization procedure. After adjusting for baseline differences, readmission rates are similar for CAS and CEA although readmission length of stay is longer after the latter. Readmission for neurological causes was more common following CAS while readmission for procedural or medical complications occurred more often following CEA. Higher annual institutional CEA volumes were associated with lower risk for 30-day readmission; in contrast, institutional CAS volumes were not related to readmission risk. These data provide important insights into the short-term, outcomes of patients following carotid artery revascularization.