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Operator Experience Tied to Carotid Stenting Mortality Risk

Operator's annual volume, experience at time of procedure impact 30-day mortality risk in elderly

TUESDAY, Sept. 27 (HealthDay News) -- Carotid stenting in older patients performed by operators with low annual volume or less experience is associated with higher 30-day mortality risk, according to a study published in the Sept. 28 issue of the Journal of the American Medical Association.

Brahmajee K. Nallamothu, M.D., M.P.H., from the University of Michigan Medical School in Ann Arbor, and colleagues investigated the association of two measures of operator's experience (annual volume and experience at the time of procedure) with procedure outcomes, among 1,792 new operators performing carotid stenting. Medicare beneficiaries (aged ≥65 years) underwent 11,846 carotid stenting procedures by new operators between 2005 and 2007. Thirty-day mortality was assessed in relation to annual operator volumes stratified as very low, low, medium, and high, and in relation to treatment performed early (first to 11th procedure) versus late (from the 12th procedure) during a new operator's experience.

The investigators found that the overall 30-day mortality rate, and the rate of failure to use an embolic protection device was 1.9 and 4.8 percent, respectively. The observed 30-day mortality was significantly higher in patients treated by lower annual volume operators versus higher volume operators and in patients treated early versus late during a new operator's experience. Patients treated by very-low-volume operators versus those treated by high-volume operators had a higher 30-day mortality, as did patients treated by operators early compared to late within the operator's experience (adjusted odds ratios, 1.9 and 1.7, respectively).

"Lower annual operator volume and early experience are associated with increased 30-day mortality," the authors write.

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