Shorter Duration of Femoral-Popliteal Bypass Is Associated with Decreased Surgical Site Infection and Shorter Hospital Length of Stay - 14/09/12
, Jeffrey A. Kalish, MD, Naomi M. Hamburg, MD, Denis Rybin, MS, Gheorghe Doros, PhD, Robert T. Eberhardt, MD, Alik Farber, MD
Correspondence address: Tze-Woei Tan, MD, Boston University Medical Center/Boston University School of Medicine, 88 East Newton St, Collamore D-506, Boston, MA 02118Résumé |
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.
Study Design |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : ACS, BMI, FPB, LOS, MR, OR, Q, SSI
Plan
| CME questions for this article available at jacscme.facs.org |
|
| Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. |
Vol 215 - N° 4
P. 512-518 - octobre 2012 Retour au numéro
Article précédent
- When Is Death Inevitable after Emergency Laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database
- Mohammed H. Al-Temimi, Matthew Griffee, Toby M. Enniss, Robert Preston, Daniel Vargo, Sean Overton, Edward Kimball, Richard Barton, Raminder Nirula
- Tracking Intraoperative Complications
- Joseph Platz, Neil Hyman
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?