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Carotid endarterectomy in the community hospital. A continuing controversy.

A retrospective review of 390 carotid endarterectomies performed in two major private hospitals over 78 months by general and neurological surgeons, was conducted. The mortality was 3.1% including five fatal strokes. Permanent neurological deficit was noted in 7.2% of survivors. Use of an intraoperative shunt, or the occurrence of postoperative hypotension did not alter the morbidity. Postoperative hypertension was clearly detrimental, while those with a stable postoperative course fared best. General vascular surgeons were classified as having had additional cardiovascular training, special interest or occasional experience in vascular surgery. Neither training nor case load appeared to affect morbidity. Individual differences within groups were greater than between groups. Improvement of statistics was noted in the second 18 months. It is concluded that the best method to improve results in the moderate sized community with a mixed pool of surgeons is to promote open and ongoing peer review of indications and results of carotid endarterectomy.