Index complications predict secondary complications after infrainguinal lower extremity bypass for critical limb ischemia
Abstract 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 Co...
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| Veröffentlicht in: | Journal of vascular surgery 2017-05, Vol.65 (5), p.1344-1353 |
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| creator | Peacock, Matthew R., MS Shah, Nishant K., BS Farber, Alik, MD Lee, Su Yeon, BS Kalish, Jeffrey A., MD Rybin, Denis, PhD Doros, Gheorghe, PhD Siracuse, Jeffrey J., MD |
| description | Abstract 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 |
| doi_str_mv | 10.1016/j.jvs.2016.10.096 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1870986123</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0741521416316573</els_id><sourcerecordid>1870986123</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-739d5e3e308d3d7605935ea3c479ad551b099dedeb9050b9e18c9c3a3c2540ee3</originalsourceid><addsrcrecordid>eNp9kc1u1TAQhS0EopfCA7BBWbLJxT9xEgsJCVVAK1ViAawtx56AQxIH22mbt2eiW7rogpXtmXOOPN8Q8prRI6Osfjcch5t05HjF95Gq-gk5MKqasm6pekoOtKlYKTmrzsiLlAZKGZNt85yc8ZZzrtrqQLar2cFdYcO0jN6a7MOciiWC8zYXCWyYnYnbo77pM8TCz300fv65-tmMxRhusQZ3OcLk81Z022JSKvoQCxt9Ri9q_NQVPtlfKDEvybPejAle3Z_n5MfnT98vLsvrr1-uLj5el7Zqqlw2QjkJAgRtnXBNTaUSEozArjJOStZRpRw46BSVtFPAWqusQAGXFQUQ5-TtKXeJ4c8KKesJvwDjaGYIa9Ksbahqa8YFStlJamNIKUKvl-gnnF8zqnfietBIXO_E9xISR8-b-_i1m8A9OP4hRsH7kwBwyBsPUSfrYbaIOILN2gX_3_gPj9x29PNO8zdskIawRqSPU-jENdXf9pXvG2e1YLVshPgL8kipeA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1870986123</pqid></control><display><type>article</type><title>Index complications predict secondary complications after infrainguinal lower extremity bypass for critical limb ischemia</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Peacock, Matthew R., MS ; Shah, Nishant K., BS ; Farber, Alik, MD ; Lee, Su Yeon, BS ; Kalish, Jeffrey A., MD ; Rybin, Denis, PhD ; Doros, Gheorghe, PhD ; Siracuse, Jeffrey J., MD</creator><creatorcontrib>Peacock, Matthew R., MS ; Shah, Nishant K., BS ; Farber, Alik, MD ; Lee, Su Yeon, BS ; Kalish, Jeffrey A., MD ; Rybin, Denis, PhD ; Doros, Gheorghe, PhD ; Siracuse, Jeffrey J., MD</creatorcontrib><description>Abstract 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.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2016.10.096</identifier><identifier>PMID: 28222984</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Kidney Injury - etiology ; Aged ; Aged, 80 and over ; Critical Illness ; Databases, Factual ; Disease-Free Survival ; Female ; Humans ; Ischemia - diagnostic imaging ; Ischemia - mortality ; Ischemia - surgery ; Logistic Models ; Lower Extremity - blood supply ; Male ; Middle Aged ; Myocardial Infarction - etiology ; Odds Ratio ; Peripheral Arterial Disease - diagnostic imaging ; Peripheral Arterial Disease - mortality ; Peripheral Arterial Disease - surgery ; Pneumonia - etiology ; Postoperative Complications - diagnosis ; Postoperative Complications - etiology ; Postoperative Complications - mortality ; Postoperative Complications - therapy ; Propensity Score ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Surgery ; Surgical Wound Infection - etiology ; Time Factors ; Treatment Outcome ; United States ; Urinary Tract Infections - etiology ; Vascular Grafting - adverse effects ; Vascular Grafting - mortality</subject><ispartof>Journal of vascular surgery, 2017-05, Vol.65 (5), p.1344-1353</ispartof><rights>Society for Vascular Surgery</rights><rights>2016 Society for Vascular Surgery</rights><rights>Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-739d5e3e308d3d7605935ea3c479ad551b099dedeb9050b9e18c9c3a3c2540ee3</citedby><cites>FETCH-LOGICAL-c474t-739d5e3e308d3d7605935ea3c479ad551b099dedeb9050b9e18c9c3a3c2540ee3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521416316573$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28222984$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Peacock, Matthew R., MS</creatorcontrib><creatorcontrib>Shah, Nishant K., BS</creatorcontrib><creatorcontrib>Farber, Alik, MD</creatorcontrib><creatorcontrib>Lee, Su Yeon, BS</creatorcontrib><creatorcontrib>Kalish, Jeffrey A., MD</creatorcontrib><creatorcontrib>Rybin, Denis, PhD</creatorcontrib><creatorcontrib>Doros, Gheorghe, PhD</creatorcontrib><creatorcontrib>Siracuse, Jeffrey J., MD</creatorcontrib><title>Index complications predict secondary complications after infrainguinal lower extremity bypass for critical limb ischemia</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Abstract 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.</description><subject>Acute Kidney Injury - etiology</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Critical Illness</subject><subject>Databases, Factual</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemia - diagnostic imaging</subject><subject>Ischemia - mortality</subject><subject>Ischemia - surgery</subject><subject>Logistic Models</subject><subject>Lower Extremity - blood supply</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - etiology</subject><subject>Odds Ratio</subject><subject>Peripheral Arterial Disease - diagnostic imaging</subject><subject>Peripheral Arterial Disease - mortality</subject><subject>Peripheral Arterial Disease - surgery</subject><subject>Pneumonia - etiology</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - therapy</subject><subject>Propensity Score</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgical Wound Infection - etiology</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Urinary Tract Infections - etiology</subject><subject>Vascular Grafting - adverse effects</subject><subject>Vascular Grafting - mortality</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1TAQhS0EopfCA7BBWbLJxT9xEgsJCVVAK1ViAawtx56AQxIH22mbt2eiW7rogpXtmXOOPN8Q8prRI6Osfjcch5t05HjF95Gq-gk5MKqasm6pekoOtKlYKTmrzsiLlAZKGZNt85yc8ZZzrtrqQLar2cFdYcO0jN6a7MOciiWC8zYXCWyYnYnbo77pM8TCz300fv65-tmMxRhusQZ3OcLk81Z022JSKvoQCxt9Ri9q_NQVPtlfKDEvybPejAle3Z_n5MfnT98vLsvrr1-uLj5el7Zqqlw2QjkJAgRtnXBNTaUSEozArjJOStZRpRw46BSVtFPAWqusQAGXFQUQ5-TtKXeJ4c8KKesJvwDjaGYIa9Ksbahqa8YFStlJamNIKUKvl-gnnF8zqnfietBIXO_E9xISR8-b-_i1m8A9OP4hRsH7kwBwyBsPUSfrYbaIOILN2gX_3_gPj9x29PNO8zdskIawRqSPU-jENdXf9pXvG2e1YLVshPgL8kipeA</recordid><startdate>20170501</startdate><enddate>20170501</enddate><creator>Peacock, Matthew R., MS</creator><creator>Shah, Nishant K., BS</creator><creator>Farber, Alik, MD</creator><creator>Lee, Su Yeon, BS</creator><creator>Kalish, Jeffrey A., MD</creator><creator>Rybin, Denis, PhD</creator><creator>Doros, Gheorghe, PhD</creator><creator>Siracuse, Jeffrey J., MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170501</creationdate><title>Index complications predict secondary complications after infrainguinal lower extremity bypass for critical limb ischemia</title><author>Peacock, Matthew R., MS ; Shah, Nishant K., BS ; Farber, Alik, MD ; Lee, Su Yeon, BS ; Kalish, Jeffrey A., MD ; Rybin, Denis, PhD ; Doros, Gheorghe, PhD ; Siracuse, Jeffrey J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-739d5e3e308d3d7605935ea3c479ad551b099dedeb9050b9e18c9c3a3c2540ee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute Kidney Injury - etiology</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Critical Illness</topic><topic>Databases, Factual</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>Ischemia - diagnostic imaging</topic><topic>Ischemia - mortality</topic><topic>Ischemia - surgery</topic><topic>Logistic Models</topic><topic>Lower Extremity - blood supply</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - etiology</topic><topic>Odds Ratio</topic><topic>Peripheral Arterial Disease - diagnostic imaging</topic><topic>Peripheral Arterial Disease - mortality</topic><topic>Peripheral Arterial Disease - surgery</topic><topic>Pneumonia - etiology</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - therapy</topic><topic>Propensity Score</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgical Wound Infection - etiology</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>Urinary Tract Infections - etiology</topic><topic>Vascular Grafting - adverse effects</topic><topic>Vascular Grafting - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Peacock, Matthew R., MS</creatorcontrib><creatorcontrib>Shah, Nishant K., BS</creatorcontrib><creatorcontrib>Farber, Alik, MD</creatorcontrib><creatorcontrib>Lee, Su Yeon, BS</creatorcontrib><creatorcontrib>Kalish, Jeffrey A., MD</creatorcontrib><creatorcontrib>Rybin, Denis, PhD</creatorcontrib><creatorcontrib>Doros, Gheorghe, PhD</creatorcontrib><creatorcontrib>Siracuse, Jeffrey J., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Peacock, Matthew R., MS</au><au>Shah, Nishant K., BS</au><au>Farber, Alik, MD</au><au>Lee, Su Yeon, BS</au><au>Kalish, Jeffrey A., MD</au><au>Rybin, Denis, PhD</au><au>Doros, Gheorghe, PhD</au><au>Siracuse, Jeffrey J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Index complications predict secondary complications after infrainguinal lower extremity bypass for critical limb ischemia</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2017-05-01</date><risdate>2017</risdate><volume>65</volume><issue>5</issue><spage>1344</spage><epage>1353</epage><pages>1344-1353</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Abstract 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28222984</pmid><doi>10.1016/j.jvs.2016.10.096</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of vascular surgery, 2017-05, Vol.65 (5), p.1344-1353 |
| issn | 0741-5214 1097-6809 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1870986123 |
| source | MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Acute Kidney Injury - etiology Aged Aged, 80 and over Critical Illness Databases, Factual Disease-Free Survival Female Humans Ischemia - diagnostic imaging Ischemia - mortality Ischemia - surgery Logistic Models Lower Extremity - blood supply Male Middle Aged Myocardial Infarction - etiology Odds Ratio Peripheral Arterial Disease - diagnostic imaging Peripheral Arterial Disease - mortality Peripheral Arterial Disease - surgery Pneumonia - etiology Postoperative Complications - diagnosis Postoperative Complications - etiology Postoperative Complications - mortality Postoperative Complications - therapy Propensity Score Registries Retrospective Studies Risk Assessment Risk Factors Surgery Surgical Wound Infection - etiology Time Factors Treatment Outcome United States Urinary Tract Infections - etiology Vascular Grafting - adverse effects Vascular Grafting - mortality |
| title | Index complications predict secondary complications after infrainguinal lower extremity bypass for critical limb ischemia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T06%3A43%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Index%20complications%20predict%20secondary%20complications%20after%20infrainguinal%20lower%20extremity%20bypass%20for%20critical%20limb%20ischemia&rft.jtitle=Journal%20of%20vascular%20surgery&rft.au=Peacock,%20Matthew%20R.,%20MS&rft.date=2017-05-01&rft.volume=65&rft.issue=5&rft.spage=1344&rft.epage=1353&rft.pages=1344-1353&rft.issn=0741-5214&rft.eissn=1097-6809&rft_id=info:doi/10.1016/j.jvs.2016.10.096&rft_dat=%3Cproquest_cross%3E1870986123%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1870986123&rft_id=info:pmid/28222984&rft_els_id=1_s2_0_S0741521416316573&rfr_iscdi=true |