Gender-based 30-day and long-term outcomes after carotid endarterectomy

Abstract. Background: We analyses the effect of gender on short and long-term morbidity and mortality in carotid endarterectomy (CEA) under loco-regional anesthesia. Patients and methods: Patients who were entered into a prospectively compiled computerized database of unilateral, consecutive CEAs performed at our hospital from January 2000 to December 2010 were analysed. Endpoints were perioperative stroke and death, and overall long-term survival rates. Statistical analysis was used to determine the relationships between gender and outcomes after CEA. A Cox proportional hazard model was applied to determine independent risk factors for long term survival. Results: A total of 1880 CEA procedures were performed in the period between 2000 and 2010. Overall, there were 28 (1.48 %) neurological deficits according to the ipsilateral carotid supply territory, including minor and major strokes. 7 occurred in the female group (1.19 %), and 21 in the male group (1.62 %) with no significant difference between the genders (p = 0.60). No significant difference emerged between female and male patients when postoperative neurological events according to the ipsilateral carotid supply territory were stratified by linical presentation (asymptomatic ICA stenosis: p = 0.75; symptomatic ICA stenosis: p = 0.66). The late overall mortality rate was 4.1% (n = 78) and 26/78 of these late deaths occurred in the female group (33 %). Log rank analysis of Kaplan Meier curves showed no statistically significant difference in long-term survival between the groups (p = 0.74). The multivariate risk factor analysis with the Cox proportinal hazard model revealed age (p < 0.00), and smoking (p = 0,02) as independent risk factors for decreased long term survival. Conclusions: When considering short and long-term outcomes in patients receiving carotid endarterectomy in local anaesthesia gender should not be regarded as a factor on decision-making for carotid interventions in both symptomatic and asymptomatic patients.