Cost and Demographic Disparities in Elective Transcarotid Artery Revascularization and Carotid Endarterectomy: A National Inpatient Sample Study

Background Carotid endarterectomy (CEA) and transcarotid artery revascularization (TCAR) are established treatments for carotid artery disease, but nonclinical procedural differences are important in determining patient selection for either procedure. The objective of this study was to evaluate and compare inhospital costs for elective CEA and TCAR procedures and to identify demographic and clinical factors associated with cost variation. Methods A retrospective cohort study was conducted using the 2019–2022 National Inpatient Sample, identifying patients who underwent elective CEA or TCAR via International classification of diseases, 10th revision procedure codes. Patients admitted emergently were excluded to control for confounding related to prehospital stroke. Demographic variables, comorbidity burden (via Elixhauser Comorbidity Index with van Walraven weighting), and hospital charges, were extracted. Hospital costs were calculated using hospital-specific cost-to-charge ratios and utilized in secondary analyses. Group-wise comparisons were performed using Mann–Whitney U and Kruskal–Wallis H tests due to nonnormality of data. Multivariable linear regression was used to assess predictors of hospital charges, with post-hoc models evaluating significant interactions. Results A total of 36,363 patients were included (34,606 CEA; 1,756 TCAR). Average total charges were significantly higher for TCAR than for CEA ($76,324.50 ± 47,866.06 vs. $52,367.17 ± 43,028.88, P < 0.001). Higher inhospital charges were associated with female sex, Hispanic ethnicity, public insurance coverage, and higher income quartile (all P < 0.05). Linear regression confirmed significant effects of age, comorbidity score, procedure type, sex, race, and insurance status on hospital charges ( P < 0.001). Secondary analyses yielded significantly higher costs for individuals undergoing TCAR, as well as for Asian/Pacific Islander Individuals. Conclusions In this national analysis, TCAR was associated with higher inhospital charges and costs than CEA, even after adjustment for demographic and clinical factors. Charges also varied significantly based on race, insurance type, comorbidity burden, and income. These findings provide valuable insight into the economic impact of carotid revascularization and may inform cost-conscious procedural decision-making.