This study assessed perioperative outcomes among patients who underwent carotid endarterectomy (CEA) with regard to patients' race/ethnicity and symptom status. The authors used data from the Veterans Affairs National Surgical Quality Improvement Program (NSQIP), in which surgical patients receive a follow-up questionnaire regarding their health status and outcomes of interest thirty days postsurgery and the patient’s clinical status is confirmed by medical record review. This study included male patients registered in the NSQIP who underwent CEA during the period from 1994 to 1997. Duplicate records were deleted. The sample size was 6,551 (346 black, 217 Hispanic, and 5,988 white).

Among all patient types, the rates of stroke/death and of stroke/myocardial infarction (MI)/death were low and did not differ statistically across racial/ethnic groups (although the rates were slightly higher for Hispanics than either blacks or whites). There were also no racial differences in complications after surgery. However, blacks and Hispanics were more likely to have a postoperative stay of greater than three days, and Hispanics were more likely to return to the operating room (OR) within 30 days or return to the OR at all for reasons related to CEA.

Since differences were observed among the three racial/ethnic groups for clinical indications of CEA (whites were less likely to have a history of stroke and more likely to have TIA), the above analyses were repeated after stratifying the groups by the following categories: asymptomatic, TIA history, and stroke history. Among those with TIA, Hispanics were more likely to have stroke/death and stroke/MI/death outcomes, and both blacks and Hispanics were more likely to have a postoperative stay of greater than three days. Among symptomatic patients, blacks were more likely to have complications after surgery and to return to the OR for reasons related to CEA. Among stroke patients, both blacks and Hispanics were more likely to have a postoperative stay longer than three days and have one or more return visits to the OR for reasons related to CEA.

Other clinical postoperative risk factor differences were also noted, and multivariate analysis that controlled for these factors generally failed to show that race/ethnicity was associated with various postoperative outcomes of CEA. One exception was that Hispanics were more likely to have at least one related return to the OR (OR=2.34).

The authors conclude that "within an equal access health care system, there are minimal racial/ethnic differences in the occurrence of major postoperative complications, and that these complications occur infrequently. (However, they note the need for further study of Hispanic men with TIA.) Racial differences in rates of CEA (reported in previous studies) cannot be attributable to racial/ethnic differences in postoperative outcomes. It is unlikely that anticipation of worse outcomes among black and other minorities is affecting clinical decision-making regarding use of CEA among racial/ethnic groups."