Modification of outcomes by lowering ischemic events after reconstruction of extracranial vessels (MOLIERE): An internet-based prospective study to evaluate and improve the effectiveness of carotid endarterectomy

Comparison of 30-day stroke or death rates, mortality rates, and stroke rates after carotid endarterectomy between participating (white bars) and nonparticipating (black bars) surgeons for all patients, symptomatic patients, and asymptomatic patients. There was a trend toward higher stroke rates after carotid endarterectomy performed by nonparticipating surgeons. The P value for each comparison is shown.

A, Overall stroke or death rates per surgeon participation in Modification of Outcomes by Lowering Ischemic Events after Reconstruction of Extracranial Vessels (MOLIERE). Each dot represents a surgeon. The three surgeons with the highest SDRs (black arrow) had low patient enrollment. All surgeons had overall, symptomatic, and asymptomatic SDRs within accepted standards. One nonparticipating surgeon had an overall SDR of 10% with 95% confidence interval (CI) within accepted standards. B, Overall stroke or death rates per center participation in MOLIERE. Each dot represents a participating center. The center with the highest SDRs (black arrow) was also the center with the lowest patient inclusion rate in MOLIERE. Volume (n) per center is also depicted.