title: Perioperative outcomes of elective inflow revascularization for lower extremity claudication in the American College of Surgeons National Surgical Quality Improvement Program database.
abstract: BACKGROUND
  We compared the early postoperative morbidity and mortality rates of contemporary aortofemoral bypass (AFB) and other inflow procedures for claudication.
  
  
  METHODS
  We identified 1974 claudicants who underwent elective AFB (n = 566) or non-AFB (nonaortofemoral bypass [NAFB]; n = 1408) inflow reconstruction using the ACS-NSQIP database (2005 to 2012). Stent placement was not routinely captured. In propensity score-matched cohorts, we analyzed the association between type of inflow surgery and 30-day postoperative outcomes.
  
  
  RESULTS
  Among 824 propensity score-matched patients (AFB, n = 412; NAFB, n = 412), the 30-day mortality rate was 2.7% for AFB and .0% for NAFB (P = .0008). NAFB conferred significantly lower rates of major cardiac (.2% vs 2.4%, P = .0063), respiratory (.7% vs 10.9%, P < .0001), renal (.2% vs 1.9%, P = .0380), and septic (.5% vs 3.6%, P = .0014) complications, and fewer returns to the operating room (4.6% vs 9.9%, P = .0032), compared with AFB. Rates of major venous thrombosis, wound complications, peripheral nerve injury, and graft failure were similar between the groups.
  
  
  CONCLUSIONS
  This study reports a higher contemporary short-term complication rate with AFB compared to alternative inflow revascularization, against which future study of long-term durability may be weighed.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Arin L
authors.initials: AL
authors.lastname: Madenci
authors.affiliation: Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: C Keith
authors.initials: CK
authors.lastname: Ozaki
authors.affiliation: Division of Vascular Surgery, Veteran Affairs Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA.
authors.forename: Naren
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Division of Vascular Surgery, Veteran Affairs Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Raffetto
authors.affiliation: Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Belkin
authors.affiliation: Division of Vascular Surgery, Veteran Affairs Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA. Electronic address: james.mcphee@va.gov.
authors.forename: James T
authors.initials: JT
authors.lastname: McPhee
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality*; D015397:Program Evaluation; D057216:Propensity Score; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Aortic diseases; Aortofemoral bypass; Intermittent claudication; Peripheral arterial disease