OBJECTIVES:

This study investigated the relationship between annual hospital volume and the outcomes in carotid endarterectomy and quantified critical volume threshold for this procedure.

DATA SOURCES:

PubMed, EMBASE and the Cochrane library were searched for all articles on the volume-outcome relationship in CEA.

REVIEW METHODS:

Articles were included if they presented data on post-operative mortality and/or stroke rates and annual hospital volume of CEA. The review conformed to the QUOROM statement. The data were meta-analysed and a pooled effect estimate of volume on the stroke and/or mortality rates from CEA quantified, along with the critical volume threshold.

RESULTS:

Twenty-five articles, encompassing 936 436 CEA, were analysed. Significant relationships between mortality rate and stroke rate and annual volume were seen. Overall, the pooled effect estimate was odds ratio 0.78 [95% confidence interval 0.64-0.92], in favour of surgery at higher volume units, with a critical volume threshold of 79 CEA per annum.

CONCLUSIONS:

Significantly lower mortality and stroke rates were achieved at hospitals providing a higher annual hospital volume of CEA. Hospitals wishing to provide CEA should adhere to minimum volume criteria.