Authors' recommendations: Summary There is equivocal evidence of an association between hospital volume and outcome in carotid endarterectomy. Surgeon factors such as volume, training and experience; and hospital factors such as case mix, bed capacity, critical care pathways, cardiac angiography, and a vascular recovery unit, may explain any relationship. No evidence has been found to demonstrate causality. In other words, even assuming an association between hospital volume and outcome in carotid endarterectomy, increasing the volume in low-volume hospitals or transferring all patients to high-volume hospitals will not necessarily lead to improved outcomes. To address the question of causality will require examination of prospective studies over a period of centralisation of vascular services. If a volume–outcome relationship exists in carotid endarterectomy surgery, and is causal, then modelling can be used to determine the threshold for the number of procedures a vascular unit should undertake to achieve optimal outcomes. No studies have been found which used an appropriate technique to do this. The UK frameworks identified recommend a minimum of either 35 elective CEA procedures, or 75 carotid endarterectomies, per year.

Project Status: Completed

Year Published: 2012

URL for published report: http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/earlier_scoping_reports/technologies_scoping_report_2.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland, United Kingdom

Organisation Name: Scottish Health Technologies Group

Contact Address: Scottish Health Technologies Group, Delta House, 50 West Nile Street, Glasgow, G1 2NP Tel: 0141 225 6998

Contact Name: his.shtg@nhs.scot

Contact Email: his.shtg@nhs.scot

Copyright: Healthcare Improvement Scotland