Unplanned reoperations after vascular surgery Presented (podium) at the Forty-third Annual Symposium of the Society for Clinical Vascular Surgery, Miami, Fla, March 29-April 2, 2015.

Hadiza S. Kazaure, Venita Chandra, Matthew Mell

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)730-736
Number of pages7
JournalJournal of Vascular Surgery
Volume63
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

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Reoperation
Blood Vessels
Mortality
Odds Ratio
Confidence Intervals
Embolectomy
Peripheral Vascular Diseases
Quality Improvement
Hemorrhage
Transplants
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{15d317d3252d4bb196881bb46c2ff815,
title = "Unplanned reoperations after vascular surgery Presented (podium) at the Forty-third Annual Symposium of the Society for Clinical Vascular Surgery, Miami, Fla, March 29-April 2, 2015.",
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.",
author = "Kazaure, {Hadiza S.} and Venita Chandra and Matthew Mell",
year = "2016",
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doi = "10.1016/j.jvs.2015.09.046",
language = "English (US)",
volume = "63",
pages = "730--736",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
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T1 - Unplanned reoperations after vascular surgery Presented (podium) at the Forty-third Annual Symposium of the Society for Clinical Vascular Surgery, Miami, Fla, March 29-April 2, 2015.

AU - Kazaure, Hadiza S.

AU - Chandra, Venita

AU - Mell, Matthew

PY - 2016/3/1

Y1 - 2016/3/1

N2 - 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.

AB - 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.

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