Carotid Endarterectomy - Choosing a Hospital & Surgeon

How do I choose a surgeon and a hospital?

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) surveys hospitals and other care facilities to determine whether they meet the quality standards for accreditation. You can look up a hospital's accreditation status at http://www.qualitycheck.org.

If you are eligible for a carotid endarterectomy, it is very important that your procedure be done by a highly skilled surgeon at a medical center with a good success rate for this surgery.⁶ If possible, you should try to find out not just the number, but also the outcome of carotid endarterectomies performed at the hospital you are considering. Even more important than the number of surgeries the hospital performs is how many your surgeon performed. In general, the more often your surgeon performs your specific procedure, the lower your risk.

Talk to the doctor who referred you for carotid endarterectomy about your options in choosing a surgeon and hospital. Choice of hospital is greatly influenced by your choice of surgeon, as most doctors are affiliated with one or two hospitals to which they typically admit patients. Also be sure to check with your health insurance provider about which hospitals you can go to for care.

References

1. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. Jan 29 2008;117(4):e25-146.
2. Sacco RL, Adams R, Albers G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke. Feb 2006;37(2):577-617.
3. Mosca L, Banka CL, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. Mar 20 2007;115(11):1481-1501.
4. Alamowitch S, Eliasziw M, Barnett HJ. The risk and benefit of endarterectomy in women with symptomatic internal carotid artery disease. Stroke. Jan 2005;36(1):27-31.
5. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. Aug 15 1991;325(7):445-453.
6. Bates ER, Babb JD, Casey DE, Jr., et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 clinical expert consensus document on carotid stenting: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting). J Am Coll Cardiol. Jan 2 2007;49(1):126-170.
7. Chaturvedi S, Bruno A, Feasby T, et al. Carotid endarterectomy--an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. Sep 27 2005;65(6):794-801.
8. Halliday A, Mansfield A, Marro J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. May 8 2004;363(9420):1491-1502.
9. Gurm HS, Yadav JS, Fayad P, et al. Long-Term Results of Carotid Stenting versus Endarterectomy in High-Risk Patients. N Engl J Med. April 10, 2008 2008;358(15):1572-1579.