Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
J Vasc Surg. 2013 Aug;58(2):412-9. doi: 10.1016/j.jvs.2013.01.010. Epub 2013 Mar 13.
Administrative data have been used to compare carotid endarterectomy (CEA) and carotid artery stenting (CAS). However, there are limitations in defining symptom status, Centers for Medicare and Medicaid Services high-risk status, as well as complications. Therefore, we did a direct comparison between administrative data and physician chart review as well as between data collected for the National Surgical Quality Improvement Program (NSQIP) and physician chart review for CEA and CAS.
We performed an outcomes analysis on all CEA and CAS procedures from 2005 to 2011. We obtained International Classification of Diseases, Ninth Revision diagnosis codes from hospital discharge records regarding symptom status, high-risk status, and perioperative stroke. We also obtained data on all CEA patients submitted to NSQIP over the same time period. One of the study authors (R.B.) then performed a chart review of the same patients to determine symptom status, high-risk status, and perioperative strokes and the results were compared.
We identified 1342 patients who underwent CEA or CAS between 2005 and 2011 and 392 patients who underwent CEA that were submitted to NSQIP. Administrative data identified fewer symptomatic patients (17.0% vs 34.0%), physiologic high-risk patients (9.3% vs 23.0%), and anatomic high-risk patients (0% vs 15.2%). Although administrative data identified a similar proportion of perioperative strokes (1.9% vs 2.0%), this was due to the fact that these data identified eight false positive and nine false negative perioperative strokes. NSQIP data identified more symptomatic patients compared with chart review (44.1% vs 30.3%), fewer physiologic high-risk patients (13.0% vs 18.6%), fewer anatomic high-risk patients (0% vs 6.6%), and a similar proportion of perioperative strokes (1.5% vs 1.8%, only one false negative stroke and no false positives).
Administrative data are unreliable for determining symptom status, high-risk status, and perioperative stroke and should not be used to analyze CEA and CAS. NSQIP data do not adequately identify high-risk patients, but do accurately identify perioperative strokes and to a lesser degree, symptom status.
已使用行政数据来比较颈动脉内膜切除术（CEA）和颈动脉血管成形术（CAS）。然而，在定义症状状态、医疗保险和医疗补助服务中心高危状态以及并发症方面存在局限性。因此，我们对行政数据与医生病历记录进行了直接比较，对国家外科质量改进计划（NSQIP）收集的数据与 CEA 和 CAS 的医生病历记录进行了比较。
我们对 2005 年至 2011 年期间所有的 CEA 和 CAS 手术进行了结果分析。我们从出院记录中获得了国际疾病分类，第九版诊断代码，以了解症状状态、高危状态和围手术期卒中。我们还获得了同期所有接受 NSQIP 治疗的 CEA 患者的数据。其中一位研究作者（R.B.）对相同患者进行了病历记录审查，以确定症状状态、高危状态和围手术期卒中，然后对结果进行了比较。
我们确定了 2005 年至 2011 年间接受 CEA 或 CAS 治疗的 1342 名患者和 392 名接受 CEA 并提交给 NSQIP 的患者。行政数据识别出的有症状患者（17.0%比 34.0%）、生理高危患者（9.3%比 23.0%）和解剖高危患者（0%比 15.2%）较少。尽管行政数据识别出的围手术期卒中比例相似（1.9%比 2.0%），但这是因为这些数据识别出了 8 例假阳性和 9 例假阴性围手术期卒中。与病历记录相比，NSQIP 数据识别出的有症状患者更多（44.1%比 30.3%），生理高危患者更少（13.0%比 18.6%），解剖高危患者更少（0%比 6.6%），围手术期卒中比例相似（1.5%比 1.8%，只有 1 例假阴性卒中，没有假阳性）。
行政数据不可靠，无法确定症状状态、高危状态和围手术期卒中，不应用于分析 CEA 和 CAS。NSQIP 数据不能充分识别高危患者，但能准确识别围手术期卒中，在一定程度上也能识别症状状态。
