Impact of hospital-acquired infection on long-term outcomes after endovascular and open abdominal aortic aneurysm repair.
BACKGROUND
We hypothesized that infectious complications after open surgery (OPEN) and endovascular repair (EVAR) of nonruptured abdominal aortic aneurysms (AAAs) negatively affected long-term outcomes.


METHODS
Elective OPEN and EVAR cases were selected from 2005-2007 Medicare databases, and rates of postoperative infection, readmission, and longitudinal mortality were compared.


RESULTS
Forty thousand eight hundred ninety-two EVARs and 16,669 OPEN AAA repairs were evaluated. Patients with OPEN developed infection during and after the index hospitalization (12.8% and 4.9%, respectively) more often than those who had undergone EVAR (3.2% and 3.9%, respectively; P < 0.0001 for both). Patients with hospital-acquired infection compared to noninfectious ones were more likely to die during the index hospitalization (odds ratio [OR]: 3.7 [95% confidence interval {CI}: 3.22-4.30]) and within 30 days after discharge (OR: 3.6 [95% CI: 2.83-4.45]). They also were more likely to be readmitted to the hospital during 30 days after index discharge (OR: 1.8 [95% CI: 1.63-1.94]). Index infections associated with the greatest readmission were urinary tract infection after OPEN and sepsis after EVAR. Hospital-acquired infection significantly increased the duration of hospital stay (14.2 ± 13.2 vs 4.0 ± 4.4 days; P < 0.0001) and total hospital charges ($133,070 ± $136,100 vs $66,359 ± $45,186; P < 0.0001). The most common infections to develop 30 days after initial discharge were surgical site infection after EVAR (1.27%) and urinary tract infection after OPEN (1.38%).


CONCLUSIONS
Hospital-acquired infections had a dramatic effect by increasing hospital and 30-day mortality, readmission rates, and hospital resource use after AAA repair. Programs minimizing infectious complications may decrease future readmissions and mortality after AAA repair.
Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, MO.
Rumi
R
Faizer
Department of Surgery, University of Medicine and Dentistry New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ.
Viktor Y
VY
Dombrovskiy
Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, MO. Electronic address: vogeltr@health.missouri.edu.
Todd R
TR
Vogel
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000191:economics / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000191:economics / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013530:Surgical Wound Infection / Q000191:economics / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014552:Urinary Tract Infections / Q000191:economics / Q000209:etiology* / Q000401:mortality / Q000628:therapy