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	<title>Meds &#187; Surgery</title>
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		<title>Racial disparity seen in stroke-preventing surgery</title>
		<link>http://scotmay.com/2009/10/racial-disparity-seen-in-stroke-preventing-surgery/</link>
		<comments>http://scotmay.com/2009/10/racial-disparity-seen-in-stroke-preventing-surgery/#comments</comments>
		<pubDate>Sat, 24 Oct 2009 21:33:00 +0000</pubDate>
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		<description><![CDATA[Minorities are at greater risk of complications from surgery to remove blockages from the neck arteries, and are more likely than whites to have the procedure in appropriate cases, a new study finds.
The surgery, known as carotid endarterectomy, removes blockages from the carotid (neck) arteries supplying the brain, with the goal of preventing future strokes.
However, [...]]]></description>
			<content:encoded><![CDATA[<p>Minorities are at greater risk of complications from surgery to remove blockages from the neck arteries, and are more likely than whites to have the procedure in appropriate cases, a new study finds.</p>
<p>The surgery, known as carotid endarterectomy, removes blockages from the carotid (neck) arteries supplying the brain, with the goal of preventing future strokes.</p>
<p>However, the procedure carries its own risks &#8212; which include causing a stroke &#8212; and for some people with carotid blockages, the potential risks outweigh the possible benefits.</p>
<p>In the new study, reported in the journal Stroke, researchers found that compared with whites, black and Hispanic patients were more likely to have a carotid endarterectomy in inappropriate instances.</p>
<p>And overall, their rates of serious complications were higher.</p>
<p>Past research has shown that minorities are less likely to have a carotid endarterectomy when it is an appropriate option.</p>
<p>Coupled with these latest findings, it seems minorities face a &#8220;triple whammy&#8221; of underuse, overuse and greater complication risks, lead researcher Dr. Ethan A. Halm, of the University of Texas Southwestern Medical Center in Dallas, told Reuters Health in an interview.</p>
<p>Halm and his colleagues based their findings on nearly 9,100 Medicare patients who had endarterectomies performed in New York State hospitals.</p>
<p>Nearly 18 percent of Hispanic patients had the procedure inappropriately, as did 13 percent of African Americans. That compared with 8 percent of white patients.</p>
<p>The disparity was seen only among patients whose carotid blockages had never caused symptoms &#8211; that is, previous strokes or &#8220;mini-strokes&#8221; known as transient ischemic attacks. In most inappropriate cases, patients were both symptom-free and had co-existing health problems &#8212; such as high blood pressure, heart disease and diabetes &#8211; which meant that surgical risks likely outweighed the potential benefits.</p>
<p>When it came to overall complication rates, Halm&#8217;s team found that 7 percent of African Americans and 9.5 percent of Hispanics died or suffered a stroke within 30 days of surgery. That rate was roughly 4 percent among white patients.</p>
<p>For black patients, the disparity in complications appeared to be largely related to poorer overall health and the fact that they were more likely than whites to have a less-experienced surgeon.</p>
<p>The reasons for Hispanic patients&#8217; higher complication rate were not clear.</p>
<p>More research is needed to understand the reasons for the disparities and how to best overcome to them.</p>
<p>But for now, patients can take some steps for themselves, according to Halm. If they are concerned about whether a carotid endarterectomy is appropriate for them, getting a second opinion from another surgeon or neurologist is a good idea.</p>
<p>This is most important for people who are free of symptoms, Halm explained. &#8220;If you&#8217;re asymptomatic, it is not an emergency situation, and people shouldn&#8217;t feel rushed. They have time to gather more information.&#8221;</p>
<p>As for minimizing the risk of complications, Halm suggested that patients &#8212; symptom-free or not &#8212; ask their surgeon about his or her complication rate and the number of carotid endarterectomies he or she has done in the past year (an indicator of experience).</p>
<p>According to standard guidelines, Halm said, the rate of death or stroke within 30 days should be no higher than 6 percent for symptomatic patients, and no higher than 3 percent for asymptomatic patients.</p>
<p>When it comes to a surgeon&#8217;s experience, those who perform at least 30 to 40 endarterectomies a year have better outcomes, on average.</p>
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