Abstract:
OBJECTIVES:Complications after abdominal aortic aneurysm (AAA) repair resulting in reintervention increase mortality risk, but have not been well studied. Mortality after reintervention is termed failure to rescue and may reflect differences related to quality management of the complication. This study describes the relationship between reoperation and mortality and examines the effect of physician speciality on reintervention rates and failure to rescue after AAA repair. METHODS:Data were extracted for 2616 patients who underwent intact AAA repair in 2005 to 2006 from a standard 5% random sample of all Medicare beneficiaries. Patient demographics, comorbidities, hospital characteristics, repair type, and speciality of operating surgeon were collected. Primary outcomes were 30-day reoperation and 30-day mortality. Logistic regression analysis identified characteristics predicting reoperation. RESULTS:A total of 156 reoperations were required in 142 (4.2%) patients. Early mortality was far more likely for patients requiring reintervention than for those who did not (22.5% vs 1.5%; P < .0001). Of patients requiring reoperation, those requiring two or more interventions had an even higher mortality (54% vs 20%; P = .0007). Despite equivalent reoperation rates between specialities (vascular surgeons, 5.2%; others, 5.6%, P = .67), the mortality after reoperation was nearly half for vascular surgeons compared with other specialities (16.2% vs 32.3%; P = .04). The most common reason for reoperation was arterial complications (35.8%) accounting for the largest difference in mortality between vascular surgeons (30.7%) and other specialities (52.0%). CONCLUSIONS:Postoperative complications requiring reoperation dramatically increase mortality after AAA repair. Despite similar complication rates, vascular surgeons showed lower mortality rates after reoperation.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Mell MW,Kind A,Bartels CM,Smith MAdoi
10.1016/j.jvs.2011.01.030subject
Has Abstractpub_date
2011-08-01 00:00:00pages
346-51; discussion 351-2issue
2eissn
0741-5214issn
1097-6809pii
S0741-5214(11)00186-8journal_volume
54pub_type
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journal_title:Journal of vascular surgery
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doi:10.1016/j.jvs.2004.08.044
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journal_title:Journal of vascular surgery
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journal_title:Journal of vascular surgery
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.09.065
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journal_title:Journal of vascular surgery
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1067/mva.1989.vs0090437
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
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journal_title:Journal of vascular surgery
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1987-10-01 00:00:00
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journal_title:Journal of vascular surgery
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journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
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更新日期:2017-09-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.1016/j.jvs.2006.05.049
更新日期:2006-10-01 00:00:00
abstract:OBJECTIVE:The Kidney Disease Outcome Quality Initiative and Fistula First Breakthrough Initiative call for the indiscriminate creation of arteriovenous fistulas (AVFs) over arteriovenous grafts (AVGs) without providing patient-specific criteria for vascular access selection. Although the U.S. AVF rate has increased dra...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,meta分析,评审
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更新日期:2017-04-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1986.avs0030502
更新日期:1986-03-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1992.36607
更新日期:1992-05-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2001.111992
更新日期:2001-04-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.04.061
更新日期:2011-11-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jvs.2006.08.074
更新日期:2007-01-01 00:00:00
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pub_type: 评论,杂志文章
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.01.008
更新日期:2012-07-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
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更新日期:2020-11-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.02.011
更新日期:2009-07-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.01.023
更新日期:2005-04-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70356-8
更新日期:1998-02-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2004.10.039
更新日期:2005-02-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.08.037
更新日期:2020-09-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
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更新日期:2015-10-01 00:00:00
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journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2012.06.101
更新日期:2013-01-01 00:00:00