title: Unplanned reoperations after vascular surgery.
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.
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Hadiza S
authors.initials: HS
authors.lastname: Kazaure
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Venita
authors.initials: V
authors.lastname: Chandra
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif. Electronic address: mwmell@stanford.edu.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Mell
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality