Sydenham Society: assessing the appropriateness of carotid endarterectomy

The issues related with overuse, a medical mistake, defined as the provision of health services for which the potential risks outweigh the benefits, are discussed. Overuse is the delivery of inappropriate care and it has been estimated that approximately 20% of health care is inappropriate. Researchers at RAND Corporation and the Unversity of California, Los Angeles, conducted a comprehensive study to measure the rates of appropriateness for several procedures, including carotid endarterectomy (CEA). A subsequent appropriateness study of CEA by the Academic Medical Center Consortium (AMCC) added that the judgment about appropriateness was influenced by the actual definition of what constituted an acceptable risk of perioperative complications. The study was conducted to assess the appropriateness and indications for CEA after publication of the international RCTs, and examine the impact of comorbidity on risk of major complications.