Outcomes of Aortic Surgery for Abdominal Aortic Graft Infections.
BACKGROUND
Literature on postoperative outcomes following aortic surgery for aortic graft infection (AGI) is limited by relatively small sample sizes, resulting in lack of national benchmarks for quality of care. We report in-hospital outcomes following abdominal aortic surgery for AGI and identify factors associated with postoperative complications using the Nationwide Inpatient Sample (NIS) database.


METHODS
Patients who underwent aortic graft resection for AGI were identified from the 2002 to 2008 NIS database, a multicenter database capturing 20% of all US admissions. Multivariable logistic regression analyses were performed.


RESULTS
Among 394 patients (men: 73.4%) who underwent abdominal aortic surgery for AGI, 53% of the admissions were emergent/urgent. A significant trend for decreasing number of abdominal aortic surgery for AGIs per year was observed (Pearson r correlation: -.96; P = .0006). Over the same time span, a significant correlation was also seen with decrease in open and increase in endovascular aortic aneurysm repairs in the NIS database. In-hospital rates of overall postoperative morbidity and mortality were 68.3% and 19.8%, respectively. In-hospital rates of postoperative respiratory failure, renal failure, and cardiac arrest were 35.5%, 14.2%, and 8.9%, respectively. Median length of stay was 26 days, with median hospital charges being US$184 162. On multivariable analysis, increase in age per year (odds ratio [OR] 1.07; 95% confidence interval [CI]: 1.03-1.12) was independently associated with postoperative morbidity, while higher hospital volume for this procedure was protective (OR: 0.71; 95% CI: 0.56-0.89). No preoperative factors were independently associated with postoperative mortality.


CONCLUSIONS
Incidence of abdominal aortic surgery for AGI has progressively declined over the span of our study in association with decreased open and increased endovascular aortic aneurysm repairs. Aortic surgery for AGI is associated with very high morbidity and mortality rates along with prolonged lengths of stay and elevated hospital charges. The outcomes of operations for AGI are better in younger patients and higher volume hospitals.
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA Department of Surgery, Methodist Le Bonheur Healthcare, Memphis, TN, USA pgupta5@uthsc.edu.
Prateek K
PK
Gupta
Department of Surgery, University of California, San Francisco, CA, USA.
Bala
B
Ramanan
Departments of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Leonid
L
Grossman
Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
Himani
H
Gupta
Biostatistical Core, Creighton University, Omaha, NE, USA.
Xiang
X
Fang
Departments of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Jason N
JN
MacTaggart
Veterans Health Administration, Washington, DC, USA.
Thomas G
TG
Lynch
Departments of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
B Timothy
BT
Baxter
Departments of Surgery, University of Nebraska Medical Center, Omaha, NE, USA Department of Surgery, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA.
Iraklis I
II
Pipinos
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000191:economics / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000191:economics; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000191:economics / Q000295:instrumentation* / Q000401:mortality; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000191:economics / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000191:economics / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
aortic; graft; infection; resection