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Thomas G. Brott, MD; Richard F. Kempczinski, MD
University of Cincinnati Medical Center

CPT Robert J. Labutta, MC
Walter Reed Army Medical Center Washington, DC

JAMA. 1986;256(18):2515-2516.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

Dr Graham concludes that our citywide study of carotid endarterectomy inaccurately represented the national results of surgical intervention for carotid artery disease. We disagree. The Cincinnati operative mortality of 2.8% in 1980 and 2.3% in 1983-1984 was nearly identical to the 2.8% reported for the United States in 1982.¹ National population-based data are not available for the US carotid endarterectomy operative stroke rate. A just-published study from 46 neurosurgical centers geographically distributed around the country reported an operative stroke rate of 4.2% for 3328 operations performed in 1981. This rate was only slightly lower than the 5.1% reported for Cincinnati in 1983-1984, and the study methods did not include a page-by-page chart review.²

Dr Graham and Dr Edwards both question the influence of surgical training, experience, and caseload on operative morbidity and mortality. Our analysis of these variables for 1980³ and 1983-1984⁴ failed to . . . [Full Text PDF of this Article]

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