Back to 2016 Annual Symposium Abstacts

Objectives: Patients undergoing lower extremity bypass (LEB) are at high risk of perioperative complications. These index complications can lead to a cascade of secondary complications. Our goal was to understand how index complications alter the pattern and risk of secondary complications after LEB.
Methods: The 2005-2012 ACS-NSQIP database was used to analyze the associations of secondary complications with five index complications: acute renal failure (ARF), myocardial infarction (MI), pneumonia, deep/organ surgical site infection (SSI), and urinary tract infection (UTI) after LEB. Index cohorts were developed with 1:3 propensity matching based on preoperative variables.
Results: There were 20,230 LEB analyzed. Patients with index ARF had higher subsequent pneumonia (12.5% vs. 2.3%, P<.001), cardiac arrest (8.0% vs. 0.4%, P<.001), unplanned intubation (21.6% vs. 1.1%, P<.001), prolonged ventilation (28.4% vs. 1.5%, P<.001), and mortality (23.9% vs. 1.9%, P<.001). Patients with index MI had higher subsequent ARF (5% vs. 0.6%, P<.001), pneumonia (7.7% vs. 1.0%, P<.001), UTI (3.3% vs. 1.2%, P<.02), cardiac arrest (9.8% vs. 1.3%, P<.001), deep vein thrombosis (DVT) (3.0% vs. 0.7%, P=.003), unplanned intubation (18.4% vs. 1.6%, P<001), prolonged intubation (12.5% vs. 1.2%, P<.001), sepsis (8.6% vs. 2.0%, P<001), and mortality (16% vs. 2.8%, P<.001). Index pneumonia led to higher subsequent ARF (2.7% vs. 0.4%, P=.003), MI (6.6% vs. 0.6%, P<.001), UTI (6.9% vs. 2.2%, P=.001), cardiac arrest (6.6% vs. 0.8%, P<.001), pulmonary embolism (PE) (1.5% vs. 0%, P=.004), DVT (4.2% vs. 1.0%, P=.002), unplanned intubation (29.3% vs. 0.8%, P<.001), prolonged intubation (26.3% vs. 0.8%, P<.001), sepsis (19.3% vs. 2.7%, P<.001), and mortality (18.1% vs. 3.6%, P<.001). SSI had higher subsequent ARF (1.1% vs. 0.1%, P=.004), UTI (1.9% vs. 0.8%, P=.04), cardiac arrest (1.8% vs. 0.3%, P=.001), wound disruption (13.9% vs. 0.7%, P<.001), DVT (1.2% vs. 0.2%, P=.007), unplanned intubation (2.6% vs. 0.4%, P<.001), prolonged ventilation (2.3% vs. 0.3% P<.001), sepsis (19.2% vs. 1.2%, P<.001), and mortality (3.0% vs. 1.1%, P=.003). Index UTI led to higher subsequent pneumonia (5.6% vs. 0.6%, P<.001), unplanned intubation (4.2% vs. 1.0%, P<.001), prolonged ventilation, sepsis (3.9% vs. 0.6%, P<.001), wound disruption (3.7% vs. 1.6%, P=.03), and mortality (4.2% vs. 2.0%, P=.03).
Conclusion: LEB patients that develop postoperative index complications are significantly more likely to develop certain secondary complications. Early identification and treatment of subsequent complications could decrease morbidity and mortality.