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Hospital mortality rate on average is 20% higher in non-trial hospitals.

Hospital mortality rate on average is 20% higher in non-trial hospitals. 60% of hospitals perform fewer than 17 CEA per year. 88% of surgeons perform at or below median value of 21 CEA per year.

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Hospital mortality rate on average is 20% higher in non-trial hospitals.

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  1. Hospital mortality rate on average is 20% higher in non-trial hospitals. • 60% of hospitals perform fewer than 17 CEA per year. • 88% of surgeons perform at or below median value of 21 CEA per year. • Stroke morbidity is 7.7% in hospitals performing CEA at numbers in the lowest quartile vs 2.5% for the highest quartile (p< 0.03). • CEA results are clearly better in high volume institutions / surgeons.

  2. Carotid Endarterectomy 1971 to 1999 (Rates per Thousand) 1971-- 15,000 CEA performed in U.S. 1974-1985 - CEA most common vascular operation > 1 million worldwide. 1986 and 1988 -Rand data - “substantially overused” 1988-present- complex, randomized, multi-center controlled clinical efficacy trials

  3. 1954-- First carotid reconstruction for stroke prevention 1955 -- First CEA using techniques similar to 1999. 1971 -- 15,000 CEA performed in U.S. 1974-1985 - CEA became firmly established as the most common peripheral vascular operation with over 1 million performed worldwide. 1986 and 1988- Rand Corp data - CEA “substantially overused”

  4. Carotid Endarterectomy 1971 to 1998 (Rates per Thousand) Year

  5. CEA Cases/Quarter/100,000State of Florida 1992-1996 ACAS Advisory

  6. Florida CEA Procedures as Percent of 1992-Q1 Adjusted for Age

  7. 1988-present -- an unprecedented series of complex, randomized, multi-center controlled clinical efficacy trials have been initiated and completed. • NASCET (1991, 1998) • ECST (1991, 1996) • VA Cooperative Studies Program (1991) • CASANOVA (1991) • VA Cooperative Study Group (1993) • ACAS (1995) • ACST (ongoing)

  8. Trials for symptomatic and asymptomatic stenosis %

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