Evolution of Practices in Carotid Surgery: Observational Study in France from 2006 to 2015.

BACKGROUND: The principal objective of this study is to determine the evolution of surgical management of stenosis of carotid bifurcation over a period of 10 years in France. The secondary objective is to ascertain the impact of recommendations and of the literature on the evolution of these practices.

METHODS: From the registry of the "Agence Technique de l'Information sur l'Hospitalisation" we collected all the data for carotid surgery procedures carried out in French healthcare establishments between 2006 and 2015. The search was conducted using the common classification of medical procedures for open surgery and endovascular treatment, and diagnosis-related groups corresponding to neurovascular disease. We conducted a descriptive analysis of data year-by-year and analyzed the number of procedures, the evolution of the type of surgery according to the type of establishment, and the mean duration of hospital stays.

RESULTS: During the study period, 165,276 classical procedures (95.8%) and 7319 endovascular procedures (4.2%) of carotid bifurcation were performed. The overall number of procedures was stable over time at a mean of approximately 17,000 procedures per year. Concerning conventional surgery, eversion endarterectomy became the main technique from 2008 onwards, superseding open endarterectomy with patch closure, whereas direct primary closure of the carotid bifurcation has been declining steadily ever since. The use of a shunt declined steadily from 16.3% in 2006 to 13.3% in 2015. Endovascular treatment progressed steadily during the study period from 455 procedures (2.7% of procedures) in 2006 to 943 procedures (5.7%) in 2015. The mean hospital length of stay for patients without associated severe comorbidity was constant for classical surgery (mean of 5.4 days).

CONCLUSION: This observational analysis showed stability in the number of carotid procedures performed during the period and a progressive modification of carotid surgery practices in France, in accordance with the recommendations of learned societies and major publications.