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Nancy J. Merrick, MD, MSPH; Robert H. Brook, MD, ScD; Arlene Fink, PhD; David H. Solomon, MD

JAMA. 1986;256(18):2531-2535.

Abstract
Although carotid endarterectomy is a controversial and frequently performed surgical procedure, little is known about the clinical appropriateness of its use in actual practice. Are the majority of procedures performed for highly accepted clinical reasons? We studied the clinical appropriateness of 107 procedures performed on 95 patients in 1981 in five Veterans Administration teaching medical centers. Standards for judging appropriate use were based on the recommendations of a multidisciplinary panel of nine physicians. Fifty-five percent of the procedures studied were judged clearly appropriate, 32% equivocal, and 13% clearly inappropriate. The rate of serious operative complications was 5.6% These results suggest that carotid endarterectomy is overutilized within at least some segments of the Veterans Administration population.

(JAMA 1986;256:2531-2535)

Author Affiliations
From the Robert Wood Johnson Clinical Scholars Program, Veterans Administration Medical Center, Wadsworth, Calif (Dr Merrick); the Departments of Medicine (Drs Brook, Fink, and Solomon) and Public Health (Drs Brook and Fink), UCLA Center for the Health Sciences, Los Angeles; and Fink and Kosecoff, Santa Monica, Calif (Dr Fink). Dr Merrick is now with the Prospective Payment Assessment Commission, Washington, DC.

Footnotes
The opinions expressed herein are not necessarily those of the Veterans Administration.

Reprint requests to Prospective Payment Assessment Commission, 300 Seventh St SW, Washington, DC 20024 (Dr Merrick).

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