The need for treatment of hemodynamic instability following carotid endarterectomy is associated with increased perioperative and 1-year morbidity and mortality

摘要: Objective The objective of this study was to evaluate the outcomes patients after carotid endarterectomy (CEA) who developed postoperative hypertension or hypotension requiring administration intravenous vasoactive medication (IVMED). Methods We examined consecutive, primary elective CEA performed by 128 surgeons within Vascular Study Group New England (VSGNE) database (2003-2010) and compared required IVMED treat hyper- with those did not. Outcomes included perioperative death, stroke, myocardial infarction (MI), congestive heart failure (CHF), hospital length stay, 1-year stroke death. Propensity score matching facilitate risk-adjusted comparisons. Multivariable regression models were used compare association between in unmatched matched samples. Factors associated use evaluated, predictive performance multivariable using receiver operating characteristic (ROC) curves. Results Of 7677 CEAs identified, 23% received for treatment either (11%) (12%). Preoperative neurological symptomatic status (20%) similar across cohorts. In crude sample, increased 30-day mortality (0.7% vs 0.1%; P  = .018), MI (2.4% 0.5%; .003). Smoking, coronary artery disease, clopidogrel (ROC, 0.59) IVMED, whereas conventional general anesthesia 0.58). unitization varied 11% 38% VSGNE, center effect not affect outcomes. Conclusions Postoperative is mortality, cardiac complications, significant cardiac, as well death following CEA. utilization centers and, such, further investigation into practice needs occur order improve these at-risk patients.