title: Impact of renal insufficiency on short-term morbidity and mortality after lower extremity revascularization: data from the Department of Veterans Affairs' National Surgical Quality Improvement Program.
abstract: Few data are available on the impact of renal insufficiency on short-term operative outcomes after lower extremity surgical revascularization. We used prospectively collected data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to explore the association with renal dysfunction of adverse outcomes occurring within 30 d of lower extremity surgical revascularization in a cohort of all patients undergoing at least one lower extremity surgical revascularization from 1/1/94 to 9/30/01 (n = 18,217). Even moderate renal insufficiency (estimated GFR 30-59cc/min/1.73m(2)) was associated with an increased incidence of postoperative death (adjusted odds ratio (OR) 1.44, 95% confidence interval (CI), 1.17 to 1.77, P = 0.001), cardiac arrest (OR 1.43, CI 1.09 to 1.88, P = 0.011), myocardial infarction (OR 1.68, 1.39 to 2.16, P < 0.001), unplanned intubation (OR 1.69, CI 1.39 to 2.07, P < 0.001) and prolonged intubation (OR 1.57, CI 1.28 to 1.94, P < 0.001) within 30 d of lower extremity revascularization. However, the incidence of wound infection and graft failure requiring return to the operating room did not appear to be substantially higher in this group. Our data also show that patients with renal insufficiency undergoing revascularization were more likely to require distal procedures and to present with limb-threatening infection compared to those with normal renal function. Efforts to improve pre-and post-operative care in patients with renal insufficiency undergoing lower extremity revascularization should take into account the increased incidence of postoperative death and cardiopulmonary complications in this group in addition to more traditional concerns about operative site complications. Further studies are needed to explore reasons for the higher rate of limb-threatening infection in patients with renal insufficiency undergoing revascularization.
authors.affiliation: Department of Medicine, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA. annohare@yahoo.com
authors.forename: Ann M
authors.initials: AM
authors.lastname: O'Hare
authors.forename: Joe
authors.initials: J
authors.lastname: Feinglass
authors.forename: Anton N
authors.initials: AN
authors.lastname: Sidawy
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Rudolph A
authors.initials: RA
authors.lastname: Rodriguez
authors.forename: Jennifer
authors.initials: J
authors.lastname: Daley
authors.forename: Shukri
authors.initials: S
authors.lastname: Khuri
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Johansen
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality*; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs; D014656:Vascular Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data*