Surgeon Experience Matters in Neck Artery Procedure: Study

Patient death rate within 30 days higher if doctor has less experience with carotid stenting

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By Randy Dotinga
HealthDay Reporter

TUESDAY, Sept. 27 (HealthDay News) -- New research suggests that older patients who undergo surgery to open up clogged arteries in the neck are more likely to die within a month if their surgeon is inexperienced, although the risk is still small.

Even so, stenting may still be appropriate for some of these patients, said study author Dr. Brahmajee K. Nallamothu, an associate professor of internal medicine at the University of Michigan Health System.

"The paper is meant more as a wake-up call for ensuring that we deliver this new procedure more optimally by placing it in the hands of operators who have the most familiarity with it," he said.

At issue is a procedure known as carotid stenting, which is performed on patients whose neck arteries are blocked and are either at risk for a stroke or mini-stroke, or who have already had one.

Surgeons guide a catheter placed in the groin up to the neck, where they prop open an artery using a tube-like device called a stent. The procedure is complex and requires vascular surgeons to learn new skills instead of adapting ones that they already have, Nallamothu explained.

In the new study, researchers examined the medical records of 24,701 Medicare recipients, aged 65 and older, who underwent carotid stenting procedures between 2005 and 2007. Overall, 1.9 percent of patients died within 30 days, but the death rate was higher -- 2.5 percent -- in those treated by surgeons who performed fewer than six of the procedures a year. There are a lot of surgeons with a low level of experience, Nallamothu noted. The death rate was 1.4 percent among those who performed the most procedures -- 24 or more a year.

An experience gap remained even after the study authors adjusted their statistics so they wouldn't be thrown off by factors such as high or low numbers of patients of certain ages, genders or races.

Nallamothu said patients should feel comfortable asking their surgeons about their level of experience. He added that some research has suggested that surgeons can effectively learn how to perform cardiac stenting with the help of education programs. "However," he said, "the extent to which these programs are routinely used in real-world practice and their overall quality in such settings is largely unknown."

Stents may not be the best answer for older patients with clogged neck arteries, especially those over 75, said Dr. John Francfort, chairman of the department of surgery at Good Samaritan Hospital Medical Center in West Islip, N.Y.

An alternative surgical procedure known as an endarterectomy to open up neck arteries may be a better idea, Francfort said.

The study is published in the Sept. 28 issue of the Journal of the American Medical Association.

More information

For more about the carotid arteries, visit the U.S. National Library of Medicine.

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