Influence of surgical experience on the results of carotid surgery

Objective: To assess the 30-day mortality and morbidity rates related to carotid endarterectomy on a nation-wide basis. Design: Retrospective cross-sectional study based on vascular registry Finnvasc. Materials and methods: A total of 17 465 recorded vascular and endovascular procedures included exactly 1600 carotid endarterectomies performed by 104 surgeons in 23 hospitals. Fourteen per cent of the patients were operated on for asymptomatic carotid stenosis. Results: The combined mortality and permanent stroke rate was 3.3%, without any difference between operations done on symptomatic or asymptomatic patients. There was a clear inverse association between surgeon's carotid case load and poor outcomes in carotid surgery (p<0.005), the critical patient mass per surgeon and year being 10 operations. There was no association between outcome after carotid surgery and hospital volume of carotid operations. Conclusions: Surgeon's experience in carotid surgery clearly improves the results of carotid surgery.