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Unplanned reoperations after vascular surgery.

Abstract：

OBJECTIVE:Existing literature on unplanned reoperation (UR) after vascular surgery is limited. The frequency of 30-day UR and its association with other adverse outcomes was analyzed. METHODS:Patients who underwent vascular procedures in the American College of Surgeons National Surgical Quality Improvement Program (2012) were abstracted. UR, captured by a distinct variable now available in the data set, and its association with complications, readmissions, mortality, and failure to rescue (FTR) were analyzed using bivariate and multivariate methods. RESULTS:Among 35,106 patients, 3545 URs were performed on 2874 patients. The overall UR rate was 10.1%. Among patients who underwent URs, approximately 80.4%, 15.8%, and 3.8% had one, two, and three or more reoperations, respectively; 39.4% of URs occurred after initial discharge. Median time to UR was 7 days but varied by procedure. Procedures with the highest UR rates were embolectomy (18.2%), abdominal bypass (14.4%), and open procedures for peripheral vascular disease (13.8%). Common indications for UR were hemorrhage, graft failure or infection, thromboembolic events, and wound complications. Patients with URs had higher rates of subsequent complications (49.9% vs 19.9%; P < .001), readmission (41.8% vs 7.0%; P < .001), and mortality (8.0% vs 2.5%; P < .001) than those not undergoing URs. FTR was more likely among patients who had a UR (13.6% vs 9.3%; P < .001); this varied within procedure groups. After multivariate adjustment, UR was independently associated with mortality in an incremental fashion (for one UR: adjusted odds ratio, 2.0; 95% confidence interval, 1.7-2.5; for two or more URs: adjusted odds ratio, 3.1; 95% confidence interval, 2.2-4.2). CONCLUSIONS:URs within 30 days are frequent among patients undergoing vascular surgery and are associated with worse outcomes, including mortality and FTR.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Kazaure HS,Chandra V,Mell MW

doi

10.1016/j.jvs.2015.09.046

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

730-6

issue

3

eissn

0741-5214

issn

1097-6809

pii

S0741-5214(15)02005-4

journal_volume

63

pub_type

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