Krafcik BM, et al. - This study sought to delineate the effect of reoperative carotid endarterectomy (CEA) on perioperative outcomes. Compared with index CEA, reoperative carotid surgery seemed associated with a longer operative time and higher risk for perioperative stroke. This information informs the risk-benefit analysis for reoperation.

Methods

• For patients undergoing index and reoperative CEA, researchers searched the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database between 2005 and 2014.
• They performed multivariate analysis to assess the effect of reoperative CEA on outcomes including stroke, major adverse cardiovascular event, and procedure time.

Results

• 75,943 index and 140 reoperative CEAs were identified.
• There appeared no differences regarding baseline demographics or comorbidities except that the reoperative group had a higher incidence of patients with end-stage renal disease (3.6% vs 1.1%; P = .004).
• Reoperative and index CEA groups were comparable regarding prior stroke with deficit (20.8% vs 15.4%; P = .137) and without deficit (11.5% vs 9.1%; P = .43).
• Surgical site infection (0.7% vs 0.3%; P = .462), return to the operating room (3.6% vs 4%; P = .816), readmission with 30 days (2.1% vs 6.9%; P = .810), myocardial infarction (2.1% vs 0.9%; P = .125), and perioperative death (0.7% vs 0.9%; P = .853) were similar between the reoperative and index initial CEA cohorts.
• A significantly higher rate of perioperative stroke (5.0% vs 1.6%; P = .002) and a longer operative duration (137 ± 54 vs 116 ± 49 minutes; P < .001) were evident in the reoperative cohort.
• As per multivariate analysis, reoperative CEA was an independent factor for postoperative stroke (odds ratio, 3.71; 95% confidence interval [CI], 1.61-8.57; P = .002), major adverse cardiovascular event (odds ratio, 2.76; 95% CI, 1.32-5.78; P = .007), and longer procedure time (means ratio, 1.21; 95% CI, 1.12-1.30; P < .001).