D. K. Afflu1, G. Ortega1, K. Deonarine1, T. Obisesan2, D. Rose1, D. Tran1, E. Cornwell III1, K. Hughes1 1Howard University Hospital,Department Of Surgery,Washington, DC, USA 2Howard University Hospital,Department Of Medicine,Washington, DC, USA
Introduction:
Whereas several studies regarding the outcomes of infrainguinal arterial reconstruction abound in the literature, there are relatively few multi-year nationwide studies in contemporary times. We sought to evaluate the multi-year outcomes of infrainguinal arterial bypass on a national level.
Methods:
The American College of Surgeons’ National Surgical Quality Improvement Program Database (ACS-NSQIP) was queried to identify all patients undergoing infrainguinal arterial reconstruction from 2005 to 2010. Outcomes including 30-day NSQIP-defined major complications were identified, and multivariate analyses were conducted to identify variables associated with adverse outcomes.
Results:
The study included 32,922 patients who underwent an infrainguinal lower extremity arterial reconstruction over a six-year period. The mean age was 67 years, in a primarily male population (62%). The majority of patients were non-Hispanic white (75%). The most common indication for a leg bypass was intermittent claudication (20%), followed by ischemic rest pain (12%). Median length of stay was 5 days. Mortality following infrainguinal bypass was 3.2% and graft failure rate was 4.2%. The most common complication was surgical wound infection (10.4%). Additional postoperative complications included cardiac in 2.5%, pulmonary in 5.6% and renal in 3.7%. Overall, the rate of major complications was 27%. Factors associated with an increased odds of mortality included renal comorbidity (OR 3.65, 95% CI 2.99 – 4.44) and pulmonary comorbidity (OR 2.09, 95% CI 1.77 – 2.47). Female gender was associated with a slight increase in mortality (OR 1.18, 95% CI 1.01 – 1.37). Cardiac comorbidity (OR 1.94, 95% CI 1.36 – 2.78), black ethnicity (OR 1.45, 95% CI 1.27 – 1.72) and smoking (OR 1.20, 95% CI 1.06 – 1.37) were associated with increased odds of graft failure.
Conclusion:
Although the mortality rate is relatively low for infrainguinal arterial reconstruction in contemporary times, the high overall complication rate suggests that rigorous indications be utilized when deciding to perform these operations.