Index complications predict secondary complications after infrainguinal lower extremity bypass for critical limb ischemia

Autor: Jeffrey A. Kalish, Jeffrey J. Siracuse, Matthew R. Peacock, Denis Rybin, Alik Farber, Gheorghe Doros, Su Yeon Lee, Nishant K. Shah
Rok vydání: 2016
Předmět:
Male
Time Factors
Databases
Factual
medicine.medical_treatment
Myocardial Infarction
030204 cardiovascular system & hematology
0302 clinical medicine
Postoperative Complications
Ischemia
Risk Factors
Odds Ratio
Medicine
Intubation
030212 general & internal medicine
Myocardial infarction
Registries
Aged
80 and over
Acute Kidney Injury
Middle Aged
Treatment Outcome
Lower Extremity
Anesthesia
Urinary Tract Infections
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Critical Illness
Risk Assessment
Disease-Free Survival
Sepsis
03 medical and health sciences
Peripheral Arterial Disease
Humans
Surgical Wound Infection
Propensity Score
Aged
Retrospective Studies
business.industry
Critical limb ischemia
Odds ratio
Perioperative
Pneumonia
medicine.disease
United States
Logistic Models
Surgery
Vascular Grafting
Complication
business
Zdroj: Journal of vascular surgery. 65(5)
ISSN: 1097-6809
Popis: Objective Patients undergoing lower extremity bypass (LEB) are at high risk of perioperative complications that can lead to a cascade of secondary complications. Our goal was to understand the association of index complications with secondary complications after LEB. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2012 was used to analyze secondary complications after five index complications after LEB: deep/organ space surgical site infection, urinary tract infection (UTI), myocardial infarction (MI), pneumonia, and acute renal failure (ARF). Index cohorts were developed with 5:1 propensity matching for comparison. This score was based on preoperative variables and event-free days. Results We evaluated 20,230 LEB patients. Postoperative index surgical site infection increased the risk of secondary ARF (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.1-15.0), pneumonia (OR, 2.7; 95% CI, 1.0-7.4), UTI (OR, 3.1; 95% CI, 1.3-7.5), cardiac arrest (OR, 4.4; 95% CI, 1.6-12.2), wound disruption (OR, 10.5; 95% CI, 6.7-16.6), unplanned intubation (OR, 5.1; 95% CI, 2.0-12.8), prolonged ventilation (OR, 5.9; 95% CI, 2.0-17.6), sepsis (OR, 16.2; 95% CI, 10.2-25.6), and mortality (OR, 3.5; 95% CI, 1.7-7.1). Postoperative index UTI was associated with pneumonia (OR, 5.6; 95% CI, 2.7-11.6), sepsis (OR, 7.8; 95% CI, 5.1-11.8), and mortality (OR, 2.7; 95% CI, 1.3-5.3). Postoperative index MI was associated with secondary ARF (OR, 8.7; 95% CI, 3.8-20.1), pneumonia (OR, 4.9; 95% CI, 2.7-8.8), cardiac arrest (OR; 7.4; 95% CI; 4.0-13.5), deep venous thrombosis (OR, 3.9; 95% CI, 1.7-9.1), unplanned intubation (OR, 12.2; 95% CI, 7.3-20.3), prolonged intubation (OR, 12.2; 95% CI, 6.4-23.2), sepsis (OR, 2.2; 95% CI, 1.2-3.8), and mortality (OR, 5.6; 95% CI, 3.6-8.5). Postoperative index pneumonia was associated with secondary ARF (OR, 25.5; 95% CI, 3.0-219.3), MI (OR, 7.6; 95% CI, 3.2-18.0), UTI (OR, 4.3; 95% CI, 2.0-9.0), cardiac arrest (OR, 5.2; 95% CI, 2.0-13.2), deep venous thrombosis (OR, 7.7; 95% CI, 2.1-27.4), unplanned intubation (OR, 14.7; 95% CI, 8.3-26.1), prolonged ventilation (OR, 26.0; 95% CI, 11.8-56.9), sepsis (OR, 7.2; 95% CI, 4.0-12.8), and mortality (OR, 6.0; 95% CI, 3.7-10.0). Last, postoperative index ARF was associated with increased risk of secondary pneumonia (OR, 7.16; 95% CI, 2.6-20.0), cardiac arrest (OR, 15.5; 95% CI, 1.6-150.9), unplanned intubation (OR, 6.2; 95% CI, 2.3-16.8), prolonged ventilation (OR, 8.8; 95% CI, 3.4-22.4), and mortality (OR, 8.8; 95% CI, 3.4-22.4). Conclusions A postoperative index complication after LEB is significantly more likely to lead to serious secondary complications. Prevention and early identification of index complications and subsequent secondary complications could decrease morbidity and mortality.
Databáze: OpenAIRE
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