15; P = .0167) and had the same trend compared with CRD (2.14 +/- 3.37; P = .0649). Intensive care unit (ICU) LOS was shorter for VAS (0.52 +/- 0.97) and CRD (0.30 +/- 0.71) than for RAD (2.12 +/- 4.48; P < .0001).
The mean total hospital cost was significantly greater for RAD ($20,987 +/- $26,603) and CRD ($18,182 +/- $16,364) than for VAS ($10,000 +/- $4947; P = .0011 and P < .0001, respectively). ICU cost for RAD ($5963 +/- $14,551) was also more than for VAS ($864 +/- $1514; P < .0001) and CRD ($473 +/- $1561; P < .0001). Medical supply costs were significantly greater for CRD ($8772 +/- $9546) than for VAS ($3354 selleck inhibitor +/- $2261; P < .0001) and RAD ($4964 +/- $2595; P = .0142). Total hospital cost, LOS, and medical supplies www.selleckchem.com/products/mx69.html were significantly lower for high-volume practitioners vs low-volume practitioners (P < .0001).
Conclusion: Stroke rates after CAS did not vary significantly among practitioner specialties. Hospital resource utilization did vary significantly: Vascular surgeons had the lowest utilization of hospital resources for performing CAS. High practitioner volume was associated with lower hospital resource utilization. Elucidation of factors creating resource utilization
disparities among endovascular practitioners may lead to improved patient outcomes and permit significant future cost savings for carotid interventions. (J Vasc Surg 2009;49:1166-71.)”
“Background. Metabolic syndrome (MetS) is rapidly increasing in prevalence and is associated with carotid plaque development and is a risk factor for stroke. The aim of this study is to describe the outcomes for patients with MetS after carotid revascularization (carotid endarterectomy [CEA] and carotid stenting [CAS]).
Methods. A database
of patients undergoing carotid revascularization for primary atherosclerotic lesions was queried from 1996 to 2006. MetS was defined as the presence of >= 3 of the following criteria: blood pressure >= 130 mm Hg/>= 90 min Hg; Triglycerides >= 150 mg/dL; high-density lipoproteins Nutlin-3a (HDL) <= 50 mg/dL for women and :540 mg/dL for men; fasting blood glucose >= 110 mg/dL; or Body Mass Index (BMI) >= 30 kg/m(2). Multivariate and Kaplan-Meier analyses were performed to outcomes. The average follow-up period was 4.5 years. A major adverse event (MAE) was defined as the occurrence of stroke, myocardial infarction (MI), or death.
Results. A total of 921 patients (mean age: 71 +/- 10 years; 64% male) underwent 750 CEAs and 171 CAS. Thirty-one percent were identified as having MetS, 48% were asymptomatic, 87% had hypertension, 27% had hyperlipidemia, 32% were considered diabetic, and 14% had chronic renal insufficiency. The morbidity and mortality rates for all patients were 16.9% and 1.1%, respectively. The 30-day combined stroke/death rate was 3.6%. The 30-day MAE rates were: 6.7% vs 3.3% for MetS vs No-MetS (P = .02). The 90-day MAE rates were 8.7% vs 4.9% for MetS vs No-MetS (P = .03).