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Regional variation in the utilization of carotid endarterectomy

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Presentation on theme: "Regional variation in the utilization of carotid endarterectomy"— Presentation transcript:

1 Regional variation in the utilization of carotid endarterectomy
David Magner, MD, James Mirocha, MS, Bruce L. Gewertz, MD  Journal of Vascular Surgery  Volume 49, Issue 4, Pages e1 (April 2009) DOI: /j.jvs Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

2 Fig 1 Per capita rates of carotid endarterectomy (CEA) by state reveal a large standard deviation (0.78) and wide range of cases (from 0.56 to 4.47) around the mean of 2.89 cases per 1000 Medicare enrollees. Applying the national mean rate of CEA to the population of California would have resulted in an additional 1345 CEAs being performed in 2003, a 28% increase. Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

3 Fig 2 Mean annual income is significantly (P < .0001) and inversely correlated with observed carotid endarterectomy (CEA) rates across the United States. Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

4 Fig 3 The percentage of a given state's population having earned a bachelor's degree or higher is also significantly (P < .0001) and inversely related to carotid endarterectomy (CEA) rates. Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

5 Fig 4 There appears to be no correlation between the number of vascular surgeons in a state and the per capita rates of carotid endarterectomy (CEA). Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

6 Fig 5 The per capita rate of carotid endarterectomy (CEA) increases as the per capita availability of hospital beds increases across states (P = .0003); this also holds true for other markers of provider capacity (see text). Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

7 Fig 6 The percentage of adult smokers residing in a given state was the chief explanatory variable in our multiple regression model of carotid endarterectomy (CEA) variation, explaining 41.5% of the variation (P < .0001). Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

8 Fig 7 The number of deaths secondary to cerebrovascular disease (a surrogate health marker for carotid disease burden) was also significantly and highly correlated with the variation in CEA rates (P = .0002). Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

9 Fig 8 The burden of coronary artery disease in a given population is strongly correlated with observed rates of CEA in a region (P < .0001). Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

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