Personalizar preferências de consentimento

Utilizamos cookies para ajudar você a navegar com eficiência e executar certas funções. Você encontrará informações detalhadas sobre todos os cookies sob cada categoria de consentimento abaixo.

Os cookies que são classificados com a marcação “Necessário” são armazenados em seu navegador, pois são essenciais para possibilitar o uso de funcionalidades básicas do site.... 

Sempre ativo

Os cookies necessários são cruciais para as funções básicas do site e o site não funcionará como pretendido sem eles. Esses cookies não armazenam nenhum dado pessoalmente identificável.

Bem, cookies para exibir.

Cookies funcionais ajudam a executar certas funcionalidades, como compartilhar o conteúdo do site em plataformas de mídia social, coletar feedbacks e outros recursos de terceiros.

Bem, cookies para exibir.

Cookies analíticos são usados para entender como os visitantes interagem com o site. Esses cookies ajudam a fornecer informações sobre métricas o número de visitantes, taxa de rejeição, fonte de tráfego, etc.

Bem, cookies para exibir.

Os cookies de desempenho são usados para entender e analisar os principais índices de desempenho do site, o que ajuda a oferecer uma melhor experiência do usuário para os visitantes.

Bem, cookies para exibir.

Os cookies de anúncios são usados para entregar aos visitantes anúncios personalizados com base nas páginas que visitaram antes e analisar a eficácia da campanha publicitária.

Bem, cookies para exibir.

Operator Experience and Carotid Stenting Outcomes in Medicare Beneficiaries Original Contribution

Compartilhe ►

Context Although the efficacy of carotid stenting has been established in clinical trials, outcomes of the procedure based on operator experience are less certain in clinical practice.

Objective To assess association between outcomes and 2 measures of operator experience: annual volume and experience at the time of the procedure among new operators who first performed carotid stenting after a national coverage decision by the Centers for Medicare & Medicaid Services (CMS).

Design, Setting, and Patients Observational study using administrative data on fee-for-service Medicare beneficiaries aged 65 years or older undergoing carotid stenting between 2005 and 2007.

Main Outcome Measure Thirty-day mortality stratified by very low, low, medium, and high annual operator volumes (<6, 6-11, 12-23, and ?24 procedures per year, respectively) and treatment early vs late during a new operator’s experience (1st to 11th procedure and 12th procedure or higher).

Results During the study period, 24 701 procedures were performed by 2339 operators. Of these, 11 846 were performed by 1792 new operators who first performed carotid stenting after the CMS national coverage decision. Overall, 30-day mortality was 1.9% (n = 461) and rate of failure to use an embolic protection device was 4.8% (n = 1173) . The median annual operator volume among Medicare beneficiaries was 3.0 per year (interquartile range, 1.4-6.5) and 11.6% of operators performed 12 or more procedures per year during the study period. Observed 30-day mortality was higher among patients treated by operators with lower annual volumes (2.5% [95% CI, 2.1%-2.9%], 1.9% [95% CI, 1.6%-2.3%], 1.6% [95% CI, 1.3%-1.9%], and 1.4% [95% CI, 1.1%-1.7%] across the 4 categories; P < .001) and among patients treated early (2.3%; 95% CI, 2.0%-2.7%) vs late (1.4%; 95% CI, 1.1%-1.9%; P < .001) during a new operator’s experience. After multivariable adjustment, patients treated by very low-volume operators had a higher risk of 30-day mortality compared with patients treated by high-volume operators (adjusted odds ratio, 1.9; 95% CI, 1.4-2.7; P < .001). Similarly, we found a higher risk of 30-day mortality in patients treated early vs late during a new operator’s experience (adjusted odds ratio, 1.7; 95% CI, 1.2-2.4; P = .001).

Conclusion Among older patients undergoing carotid stenting, lower annual operator volume and early experience are associated with increased 30-day mortality.

http://jama.ama-assn.org/cgi/content/short/306/12/1338?rss=1

Sent with MobileRSS for iPhone

Júlio Leonardo B. Pereira
http://lattes.cnpq.br/7687651239699170
https://neurocirurgiabr.comhttp://www.radiocirurgia.org