Medicare Patients with Symptomatic Carotid Disease Requiring Carotid Revascularization Are Likely to Have Delayed Access: An Analysis of a Multicenter Surgical Data

The Society for Vascular Surgery clinical practice guidelines management of extracranial cerebrovascular disease recommends carotid revascularization as soon the patient is neurologically stable after 48 hours and before 14 days symptom onset in patients with recent stroke. In United States, insurance status has been demonstrated to play a role wait times surgical care. There are no large-scale studies that assess effect primary on time surgery symptomatic disease. We utilized Quality Initiative (VQI) database evaluate our hypothesis associated waiting All who underwent VQI dataset from 2010 2022 were included. Patients incomplete or missing outcomes data, Modified Rankin score >2 asymptomatic excluded. Primary outcome was between intervention. Categorical variables compared using χ2 test one-way analysis variance continuous variables. Multivariable logistic regression used association while adjusting potential confounders. study consisted 11,973 had within symptoms (early cohort) 21,253 late cohort (after days). older (70.1 ± 9.8 vs 69.8 10.5; P = .02), less likely undergo endarterectomy (85.9% 88.4%; < .01), more have an elective procedure (90.3% 44.3%; .01). Fig 1 shows distribution coverage among cohort. After confounders, Medicare, recipients other insurer types lower odds experiencing delayed surgery: Medicare Advantage (adjusted ratio [aOR], 0.89; 95% confidence interval [CI], 0.80-0.99; .03), commercial (aOR, 0.84; CI, 0.78-0.90; .001), military/Department Veterans Affairs 0.67; 0.54-0.84; self-pay 0.54; 0.45-0.65; .001). Medicaid similar delay 0.90; 0.78-1.03; .14) non-US longer 1.48; 1.13-1.95; .005), comparison (Fig 2). Symptomatic receive procedures insurance. Future needed investigate potentially mitigate underlying causes overall health implications such long-term these patients.Fig 2Adjusted receiving requiring comparing major providers Medicare. *Model adjusted urgency procedure, prior coronary artery disease, endarterectomy/coronary stenting, preoperative beta-blocker use, congestive heart failure, type (carotid endarterectomy, transcarotid revascularization, transfemoral stenting), age, race, body mass index, creatinine levels, hemoglobin concentration, dysrhythmia, previous amputation, functional status, American Anesthesiologists class, chronic obstructive pulmonary degree stenosis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)