Stroke-Preventing Operation Is Safe Even For The Elderly

A widely used operation to prevent stroke by removing blockages from blood vessels in the neck is safe even for the elderly -- and safest and least expensive when done in hospitals performing the greatest number, a Johns Hopkins study has found.

Researchers report that carotid endarterectomy (CEA), the most frequently performed vascular operation, is safe even for people in their 80s and 90s, although older individuals tended to have slightly longer patient stays and higher hospital charges associated with greater medical needs.

In CEA, physicians clear plaque from the inner lining of the carotid artery, the main artery supplying blood to the head and neck. Blocked carotid arteries are one of the most common causes of stroke. More than 100,000 of the procedures are done annually in the United States alone.

Using the Maryland Health Services Cost Review Commission database, the researchers tracked 9,918 CEAs performed at 48 Maryland hospitals between 1990 and 1995. Patients ranged in age from 34 to 92. The mortality rate associated with the procedure was 0.9 percent and the stroke rate was only 1.7 percent, remarkably lower than reported in previous population-based studies, the researchers said.

In hospitals performing fewer than 10 CEAs per year, however, the death rate was 1.9 percent, compared to 0.8 percent in hospitals doing more than 50 per year. The rate of neurological complications following the surgeries also was much greater in the low-volume hospitals compared with the high-volume medical centers, 6.1 percent vs. 1.8 percent, respectively.

Results of the study were published in the January issue of the Journal of Vascular Surgery.

"There's a common belief that this procedure is not safe for people over the age of 80, although we have not found that here," says Bruce A. Perler, M.D., lead author of the study and a professor of surgery. "We've found that despite the significant aging of the population having the operation, the mortality rates and neurological complications remained stable.

"This is extremely important information since the very elderly are at the greatest risk of stroke, and thus can benefit most from this stroke-preventing operation."

The study's other authors were Alan Dardik, M.D., Ph.D.; Gregg P. Burleyson, M.H.S.; Toby A. Gordon, Sc.D.; and G. Melville Williams, M.D.