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Carotid Endarterectomy in 1,650 patients under 60 years old: Implications for Screening

Juanne M. Osigweh1, Desarom Teso1, Jared Frattini2, Stanley J. Dudrick1, Richard J. Gusberg2, Alan Dardik2,1
1St. Mary's Hospital, Waterbury, CT;2Yale University School of Medicine, New Haven, CT

Objective: Although carotid endarterectomy (CEA) is commonly performed in patients over 60 years old, several single institutional studies suggest that demographics and outcome are similar in younger and older patients. We examine the outcome of CEA in younger patients in contemporary practice.
Design: Retrospective review, state discharge database (www.cthosp.org).
Setting: General Community.
Patients: Records containing DRG 5, procedure 38.12, and diagnosis 433 codes.
Interventions: None.
Main Outcome Measures: In-hospital mortality, perioperative stroke, cardiac complications.
Results: 14,679 CEA were performed between 1990 and 2002, including 1,650 patients under 60 years old (11.2%). Younger patients were less likely to have heart disease (14.5% vs. 18.3%, p=.0001, Chi-Square) or COPD (8.8% vs. 12.4%, p<.0001) than older patients, but were more likely to present symptomatically (19.2% vs. 16.4%, p=.006) and have non-elective surgery (17.9% vs. 13.9%, p=.0007). Younger patients were more likely African-American (2.6% vs. 1.6%) or Hispanic (2.1% vs. 0.9%, p<.0001). Postoperative mortality was similar in younger patients (0.2% vs. 0.5%, p=.18) but with reduced rates of stroke (0.7% vs. 1.3%, p=.04) and cardiac complications (1.3% vs. 2.6%, p=.001).
Conclusions: Patients under 60 years old with carotid disease are more likely than older patients to be African-American or Hispanic, and to present symptomatically and urgently. Nevertheless, CEA can be performed in younger patients with excellent rates of postoperative mortality and morbidity. These results suggest that younger patients, especially African-Americans and Hispanics, currently may not be screened adequately for carotid disease, but, because treatment is safe, screening programs should include this higher risk population.

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