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Sex differences in carotid endarterectomy utilization and 30-day postoperative mortality

From the US Department of Health and Human Services, Centers for Medicare & Medicaid Services, Kansas City, MO.

Address correspondence and reprint requests to Dr. Kazim Sheikh, US Department of Health and Human Services, Centers for Medicare & Medicaid Services, 601 East 12th Street, Room 235, Kansas City, MO 64106; e-mail: ksheikh{at}cms.hhs.gov

Objective: To study trends, and sex and regional differences in utilization of the carotid endarterectomy (CEA) procedure and 30-day postoperative mortality from 1991 to 1999.

Methods: Retrospective analysis of fee-for-service claims and mortality data for Medicare beneficiaries aged 65 years and older in the United States.

Results: The male and female CEA rates and 30-day mortality increased with age up to the age of 79 years. From 1991 to 1995, the age-adjusted male and female CEA rates increased 72% from 26.6 and 14.2 procedures per 10,000 beneficiaries. Thereafter, the CEA rates slightly decreased except for the 80 years and older age group, which increased through 1999. In each year from 1991 to 1999, the age-adjusted male CEA rates were approximately 1.9 times higher than the corresponding female rates. From 1991 to 1998, the age-adjusted male and female 30-day mortality decreased 29.3% and 46.4% from 19.2 and 18.1 deaths per 1,000 procedures. From 1992 to 1997, except 1994, 30-day mortality was higher in men than in women. This sex difference was not present in the 65 to 69 years age group. There were small differences in CEA rates between two of the four regions of the United States in 3 of the 9 years.

Conclusions: Increasing CEA rates with decreasing postoperative mortality suggest that CEA may have been more frequently performed on low-risk patients. The apparent sex differences in CEA rates may not be true differences.

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