Does Surgeon Volume Bring Lower Patient Risk to Transcarotid Artery Revascularization?

Elsayed N, Ali Khan M, Janssen CB, et al. Analysis of Surgeon and Center Case Volume and Stroke or Death after Transcarotid Artery Revascularization. J Am Coll Surg. 2024, in press.

Transcarotid artery revascularization (TCAR) is a hybrid, minimally invasive approach for management of carotid artery disease; the procedure includes carotid stent placement using a small neck incision with a flow reversal system to reduce risk of intraoperative embolization-related stroke. Reported outcomes of TCAR have been similar to open carotid endarterectomy.

This article reviewed data from the Vascular Quality Initiative database (n = 22,624) over a 5-year interval ending in 2021. The primary objective of the study was to determine relationships of operative outcomes to surgeon and hospital case volume.

Surgeon and hospital volumes were divided into low (at least four cases/year), medium (at least 32 cases/year), and high (at least 64 cases/year) quantiles. The data were adjusted for potential confounders; the analysis showed that hospital volume was not related to risks for postoperative stroke or death.

High surgeon volume was associated with reduced risk for stroke or death when compared to low surgeon volume, but there was no difference in risk when outcomes of high-volume surgeons were compared to those of medium-volume surgeons.

The authors concluded that surgeons performing at the medium or high-volume levels were more likely to have low risk for postoperative stroke or death.