Key question 4: CEA complication rates
Literature search
1. endarterectomy, carotid [mesh] AND outcome and process assessment (health care) [mesh]
Yield: 690 items
Limited to "usa [ad]0, which picks up the country designation "USA" in the author affiliation/address field
Yield: 209 items
2. Related article search through PubMed
Articles related to Feasby TE, Quan H, Ghali WA. Hospital and surgeon determinants of carotid endarterectomy outcomes. Arch Neurol 2002;59:1877-81. [PMID: 12470174]
Yield: 27 items
Study inclusion criteria
Included complication rates related to CEA by 30-day rate of mortality or stroke for asymptomatic patients
Evaluated differences in outcomes by technique, including:
Different types of patches
Shunting
Eversion techniques
Evaluated differences in outcomes by surgical specialty, including:
Neurosurgery
Vascular surgery
General surgery
Evaluated differences in outcomes by nonsurgical factors:
Anesthesia type
Intraoperative ultrasonography or other imaging
Intraoperative angiography
Evaluated differences in outcomes by patient factors:
Age
Sex
Race
Included >1 surgeon and >1 hospital
Evaluated complication differences by surgical specialty, training, or experience
Evaluated complication differences by surgeon or hospital volume and by setting
Reported complication rates for asymptomatic patients
Case series, RCTs, meta-analysis
Study exclusion criteria
Evaluated only patients with combined CEA and coronary artery bypass graft surgery
Included only patients receiving stenting, angioplasty, endovascular treatment
Included only symptomatic patients or did not separate rates by symptom status
Not done in the United States
Review article without outcome data
Included only patients with previous stroke
Evaluated restenosis outcomes only
Recurrent stenosis study
Quality improvement study without complication rates listed
Utilization study without complication rates
Pseudoaneurysm study
Bilateral CEA study
Emergent CEA study
Included outcomes for only 1 surgeon or only 1 clinical site
,50 participants
Not on harms of CEA
Lacked relevant or 30-day outcomes
High-risk or special population
Incorrect study type
Key questions 1, 2, and 3: inclusion criteria
Key question 1: benefits of screening
RCT
Compared screened versus nonscreened groups
Outcomes of strokes or death
Outcomes specific for asymptomatic persons
Population generalizable to United States
Published in English
Key question 2: accuracy and reliability of screening
Ultrasonography, magnetic resonance angiography, or computed tomographic angiography screening
Asymptomatic persons
Systematic review of studies that compared screening test with gold standard of angiography
Population-based prevalence study
Population generalizable to United States
Published in English
Key question 3: benefits of CEA
RCTs of CEA comparing surgical treatment with medical treatment
Reported 30-day complication rates of CEA
Outcomes of stroke or death
Outcomes specific for asymptomatic persons
Population generalizable to United States
Published in English