Carotid body tumor excisions: Adverse outcomes of adding carotid endarterectomy

BACKGROUND: Carotid body tumors (CBT) are rare, infrequently malignant vascular neoplasms that are near the carotid bifurcation. Surgical excision is the treatment of choice, but individual surgeons or an institution cannot accumulate sufficient expertise to evaluate their outcomes with confidence. Our purpose was to report outcomes of surgical procedures for CBT from a nationwide dataset. STUDY DESIGN: Data were retrieved from the Nationwide Inpatient Sample from nonfederal hospital discharge abstracts. Data were queried for ICD-9-CM code 39.8, operations on the carotid body and vascular bodies, and code 38.2, carotid endarterectomy. Outcomes analyzed were length of stay, charges, and in-hospital mortality. RESULTS: An estimated 4,601 operations were identified, 3,746 for CBT surgical procedures only, and in 855 a carotid endarterectomy was also performed. Overall morbidity was 3.3%. Mortality with CBT alone was 2.0% but was 8.8% if carotid endarterectomy was also performed. CBT surgical procedures are most commonly performed in western states where higher elevations are found. Women constituted 59% of the population; mortality for women was higher than for men (12.4% versus 7.9%). Mortality in urban teaching hospitals was 2.1% and in nonteaching hospitals 4.9%. CONCLUSIONS: CBT surgical procedures are rare but are performed across a broad age spectrum. Mortality rate is low for patients having CBT alone but rises when CE is added. Women are more commonly affected and fare less well. Addition of CE to CBT surgical procedures and the resulting poor outcomes have not been previously described. Consideration should be given to referral of CBT patients to hospitals where mortality rates are low. (C) 2004 by the American College of Surgeons.