Carotid Endarterectomy Is a Day 1 Operation: Surgeon Experience Does Not Influence Outcomes

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Vasc Surg

Keywords

adult, cardiovascular disease, carotid artery disease, carotid endarterectomy, cerebrovascular accident, clinical outcome, cohort analysis, conference abstract, controlled study, drug combination, female, human, learning curve, machine learning, major clinical study, male, operation duration, special situation for pharmacovigilance, surgeon, surgery

Abstract

Objectives: Learning curves are well-described for many vascular procedures and are often assumed to influence operative performance and outcomes. As carotid endarterectomy (CEA) remains a foundational intervention in carotid disease management, whether this paradigm applies to CEA in contemporary practice remains unclear. Methods: Patients undergoing CEA from 2003 to 2024 were identified in the Society for Vascular Surgery Vascular Quality Initiative registry. Operator experience was quantified by numbering each surgeon’s cases chronologically. Major adverse cardiovascular events (MACEs) was the primary outcome; secondary outcomes included stroke and operative time. A machine learning model was used to estimate outcome risk as a function of surgeon experience. Changes in predicted outcome risk across sequential case experience were quantified using absolute differences (ADs). Proficiency was defined as the point at which predicted outcome risk fell below the overall cohort mean. Learning curves were generated across sequential cases and stratified by symptomatic status. Results: Among 168,736 patients undergoing carotid endarterectomy performed by 3172 unique physicians, distinct event rates changed only modestly across 500 sequential procedures. Predicted MACE decreased from 2.7% to 2.3% in symptomatic patients (AD 0.4%) and from 1.6% to 1.0% in asymptomatic patients (AD 0.6%) (Fig 1). Similarly, predicted stroke rate decreased from 1.8% to 1.6% in symptomatic patients (AD 0.2%) and from 0.9% to 0.5% in asymptomatic patients (AD 0.4%). Operative time decreased from 129 to 105 minutes with early experience, crossing the mean operative duration after 48 cases, and subsequently increased with higher surgeon experience (Fig 2). Conclusions: In contemporary practice, CEA demonstrates stable clinical outcomes across increasing surgeon experience, with only modest variation in rates of MACE and stroke. While operative efficiency improves early, clinical outcomes appear consistent even at low case volumes. These findings support the reproducibility of CEA outcomes and its role as a durable, foundational intervention in carotid disease management. [Formula presented] [Formula presented]

Volume

84

Issue

1

First Page

e255

Last Page

e256

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