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November 14, 1986

Changing Patterns in the Practice of Carotid Endarterectomy in a Large Metropolitan Area-Reply

JAMA. 1986;256(18):2515-2516. doi:10.1001/jama.1986.03380180077011

In Reply.—  Dr Graham concludes that our citywide study of carotid endarterectomy inaccurately represented the national results of surgical intervention for carotid artery disease. We disagree. The Cincinnati operative mortality of 2.8% in 1980 and 2.3% in 1983-1984 was nearly identical to the 2.8% reported for the United States in 1982.1 National population-based data are not available for the US carotid endarterectomy operative stroke rate. A just-published study from 46 neurosurgical centers geographically distributed around the country reported an operative stroke rate of 4.2% for 3328 operations performed in 1981. This rate was only slightly lower than the 5.1% reported for Cincinnati in 1983-1984, and the study methods did not include a page-by-page chart review.2Dr Graham and Dr Edwards both question the influence of surgical training, experience, and caseload on operative morbidity and mortality. Our analysis of these variables for 19803 and 1983-19844 failed to