{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T02:41:29Z","timestamp":1767840089210,"version":"3.49.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>After the 2005 National Coverage Determination to reimburse carotid artery stenting (CAS) for Medicare beneficiaries, the number of CAS procedures increased and carotid endarterectomy (CEA) decreased. We evaluated trends in surgeons\u2019 past-year CEA case-volume and 30-day mortality after CEA, and their association before and after the National Coverage Determination.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>In a retrospective cohort study of patients undergoing CEA (2001\u20132008) and CAS (2005\u20132008) using Medicare data, we described yearly trends of CEA and CAS rates, patient characteristics, and 30-day mortality after CEA. We used logistic regression adjusting for patient- and surgeon-level factors to assess the effect of surgeon case volume on 30-day mortality after CEA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>We identified 454\u2009717 CEA and 27\u2009943 CAS patients. Patients undergoing CEA in recent years were older and had more comorbidities than earlier years. CEA rates per 10\u2009000 beneficiaries declined from 18.1 in 2002 to 12.7 in 2008, whereas median surgeon past-year case-volume declined from 27 to 21. The CAS rates peaked at 2.3 per 10\u2009000 beneficiaries in 2006 but declined to 1.8 in 2008, resulting in declining overall revascularization procedure rates during 2005 to 2008. Thirty day post-CEA mortality was 1.40% (95% confidence interval, 1.34\u20131.47) in 2001 to 2002 and 1.17% (1.10\u20131.24) in 2007 to 2008. Surgeon\u2019s past-year case-volume of &lt;10 was associated with higher 30-day mortality consistently during 2001 to 2008.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>The rate of CEA procedures decreased substantially during 2001 to 2008, as did surgeon past-year case-volume. The postprocedural mortality in Medicare beneficiaries was high compared with trial patients but somewhat improved over time. Those operated by lower past-year case-volume surgeons had increased mortality.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.114.006276","type":"journal-article","created":{"date-parts":[[2015,3,20]],"date-time":"2015-03-20T14:17:22Z","timestamp":1426861042000},"page":"1288-1294","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Surgeon Case Volume and 30-Day Mortality After Carotid Endarterectomy Among Contemporary Medicare Beneficiaries"],"prefix":"10.1161","volume":"46","author":[{"given":"Hiraku","family":"Kumamaru","sequence":"first","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica J.","family":"Jalbert","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis L.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie D.","family":"Gerhard-Herman","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren A.","family":"Williams","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Ying","family":"Chen","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John D.","family":"Seeger","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Liu","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica M.","family":"Franklin","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soko","family":"Setoguchi","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., J.J.J., L.A.W., C.-Y. C., J.D.S., J.L., J.M.F.), Department of Vascular and Endovascular Surgery (L.L.N.), and Department of Cardiovascular Medicine (M.D.G.-H.), Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.); Laser Analytica, New York, NY (J.J.J.); and Duke Clinical Research Institute, Division of General..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.31.3.774"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199108153250701"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520420037035"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12228-3"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1072-7515(02)01345-5"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.03.033"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.11.019"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.11.006"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(96)70277-X"},{"key":"e_1_3_3_11_2","unstructured":"National Coverage Determination (NCD) for Percutaneous Transluminal Angioplasty (PTA) (20.7). 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Accessed August 4 2014."}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.114.006276","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T14:05:32Z","timestamp":1715609132000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.114.006276"}},"subtitle":["Before and After National Coverage Determination for Carotid Artery Stenting"],"short-title":[],"issued":{"date-parts":[[2015,5]]},"references-count":36,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2015,5]]}},"alternative-id":["10.1161\/STROKEAHA.114.006276"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.114.006276","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5]]},"assertion":[{"value":"2014-05-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-02-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-03-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}