title: Shorter duration of femoral-popliteal bypass is associated with decreased surgical site infection and shorter hospital length of stay.
abstract: BACKGROUND
  Duration of femoral-popliteal bypass is based on multiple patient-specific, system-specific, and surgeon-specific factors, and is subject to considerable variability. We hypothesized that shorter operative duration is associated with improved outcomes and might represent a potential quality-improvement measure.
  
  
  METHODS
  Patients who underwent primary femoral-popliteal bypass with autogenous vein between 2005 and 2009 were identified from the American College of Surgeons NSQIP dataset using ICD-9 codes. Operative duration quartiles (Q) were determined (Q1: ≤149 minutes, Q2: 150 to 192 minutes, Q3: 193 to 248 minutes; and Q4: ≥249 minutes). Perioperative outcomes included mortality, surgical site infection, cardiopulmonary complications, and length of hospital stay. Relevant patient-specific and system-specific confounders, including age, body mass index, smoking, diabetes, end-stage renal disease, indication, American Society of Anesthesiologists' class, type of anesthesia, intraoperative transfusion, nonoperative time in the operating room, and participation of a trainee during the procedure, were adjusted for using multivariable regression.
  
  
  RESULTS
  There were 2,644 femoral-popliteal bypass procedures in our study. Mean age was 65.9 years and 62% of patients were male. Longer duration of surgery was associated with increased perioperative surgical site infection (Q1: 6.3%; Q2: 9.0%; Q3: 10.1%; and Q4: 13.9%; p < 0.001) and longer length of stay (5.4 ± 6.8 days; 6.1 ± 6.7 days; 7.0 ± 11.3 days; 8.1 ± 8.0 days, respectively; p < 0.001). In multivariable analysis, longer operative duration was independently associated with higher surgical site infection and longer hospital length of stay. Operative duration of ≥260 minutes increased the risk of surgical site infection by 50% compared with operative time of 150 minutes.
  
  
  CONCLUSIONS
  Longer duration of femoral-popliteal bypass with autogenous vein was associated with a significantly higher risk of perioperative surgical site infection and longer hospital length of stay. Surgeon-specific parameters that lead to faster operative time might lead to improved clinical outcomes and more efficient hospital resource use.
authors: Boston University Medical Center/Boston University School of Medicine, Boston, MA 02118, USA. tzewoei@gmail.com
authors: Tze-Woei
authors: TW
authors: Tan
authors: Jeffrey A
authors: JA
authors: Kalish
authors: Naomi M
authors: NM
authors: Hamburg
authors: Denis
authors: D
authors: Rybin
authors: Gheorghe
authors: G
authors: Doros
authors: Robert T
authors: RT
authors: Eberhardt
authors: Alik
authors: A
authors: Farber
mesh_terms: D000368:Aged; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D011150:Popliteal Artery / Q000601:surgery*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods