Goodney Philip P, Travis Lori L, Malenka David, Bronner Kristen K, Lucas F Lee, Cronenwett Jack L, Goodman David C, Fisher Elliott S
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):15-24. doi: 10.1161/CIRCOUTCOMES.109.864736. Epub 2009 Dec 8.
To describe geographic variation in population-based rates of carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed in Medicare beneficiaries.
Medicare claims and enrollment data were used to calculate age, sex, and race-adjusted rates of CAS and CEA for Medicare beneficiaries in each of 306 hospital referral regions between 1998 and 2007. Procedures were identified using a combination of Current Procedural Terminology codes as well as diagnostic and procedural ICD-9 codes. Overall, the rate of carotid revascularization has fallen slightly over the last decade (3.8 procedures per 1000 in 1998, 3.1 procedures per 1000 in 2007; P<0.0001). Although the use of CEA decreased, from 3.6 to 2.5 procedures per 1000 beneficiaries in 2007 (P<0.0001), the use of CAS has increased >4-fold between 1998 and 2007, growing from 0.1 to 0.6 CAS procedures per 1000 beneficiaries (P<0.0001). Further, CAS rapidly disseminated across the country over the last decade. In 1998, 66% of hospital referral regions had a hospital that performed CAS; however, by 2007, nearly all (95%) hospital referral regions performed CAS (P<0.0001). Last, in regions with the highest utilization rates of CAS, it appeared that CAS was performed as a substitute for CEA. There was little evidence that CAS was being performed in addition to CEA, as no correlation existed between regional rates of CAS and CEA (r=0.06).
Even though CEA was used less frequently in 2007 than 1998, the use of CAS has grown significantly. Although regional variation in the use of CEA has remained fairly constant, regional variation has increased in the use of CAS. Given these changes in practice patterns, careful examination of the efficacy and cost-effectiveness of CAS is necessary.
描述医疗保险受益人中基于人群的颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）发生率的地理差异。
利用医疗保险理赔和参保数据，计算1998年至2007年间306个医院转诊区域中每个区域医疗保险受益人的年龄、性别和种族调整后的CAS和CEA发生率。通过结合当前操作术语代码以及诊断和操作ICD-9代码来识别手术。总体而言，在过去十年中，颈动脉血运重建率略有下降（1998年每1000人中有3.8例手术，2007年每1000人中有3.1例手术；P<0.0001）。尽管CEA的使用有所减少，从2007年每1000名受益人中的3.6例降至2.5例（P<0.0001），但在1998年至2007年间，CAS的使用增加了4倍多，从每1000名受益人中的0.1例增加到0.6例（P<0.0001）。此外，在过去十年中，CAS在全国迅速普及。1998年，66%的医院转诊区域有医院进行CAS手术；然而，到2007年，几乎所有（95%）医院转诊区域都进行了CAS手术（P<0.0001）。最后，在CAS使用率最高的地区，似乎CAS是作为CEA的替代手术进行的。几乎没有证据表明在进行CEA的同时还进行CAS，因为CAS和CEA的区域发生率之间没有相关性（r=0.06）。
尽管2007年CEA的使用频率低于1998年，但CAS的使用显著增加。尽管CEA使用的区域差异保持相对稳定，但CAS使用的区域差异有所增加。鉴于这些实践模式的变化，有必要仔细研究CAS的疗效和成本效益。
