BACKGROUND AND PURPOSE: The value of carotid endarterectomy (CEA) has been defined by several recent multicenter trials. The clinical effect of these trials remains undetermined since the Asymptomatic @entity2998 Study (ACAS) Clinical Advisory (dated September 28, 1994). METHODS: @entity1 undergoing CEA (ICD-9-CM 38.12) in nonfederal Florida hospitals were identified from the discharge database. Data were analyzed by federal fiscal year (FY, October 1 through September 30), comparing the years following the Advisory (FY95-FY96) to the preceding 3 years (FY92-FY94). RESULTS: There was a 68.3% increase in the number of CEAs during FY95-FY96 (mean FY92-FY94, 7,343; mean FY95-FY96, 12,356). This exceeded increases in total hospital discharges (4.5%), surgical discharges (2.2%), and the state's population (4.7%). The increase in CEAs spanned all @entity1 demographic groups (gender, race, and age), although the magnitude was not consistent (range, 57.8% increase for 55 to 64 age group; 92.9% increase for > 84 age group). Concomitantly, there was a significant decrease in mortality (1.2% versus 0.8%), @entity299 rate (ICD-9-CM 997.1, 4.1% versus 3.0%) and percentage of @entity1 discharged > 7 days postoperatively (8.9% versus 4.9%). Mean length of stay declined 28% (5.8 versus 4.1 days), and mean adjusted charges declined 7% ( 19,456 versus  18,055). Although the average case was less costly, the increased volume resulted in an estimated  56 million increase in annual hospital payments. CONCLUSIONS: The dramatic increase in the number of CEAs performed in the state of Florida after release of the ACAS Clinical Advisory suggests a causal relationship and mandates further cost-effectiveness analyses.

Effect of the Asymptomatic XXXX Study on carotid endarterectomy in Florida.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity2998 :: ('MESH:D002340', 'Disease') :: ['Carotid Atherosclerosis'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac complication']
@entity2998 :: (MESH:D002340,Disease) :: ['Carotid Atherosclerosis']
