Perioperative Reoperation Is Associated With Increased Risk Of Morbidity And Mortality Among Elderly Patients Undergoing Lower Extremity Bypass
Bradley Trinidad, MD, Tze-Woei Tan, MD.
Banner University-University of Arizona Tucson, Tucson, AZ, USA.
OBJECTIVES: As the population continues to age there is an increased number of revascularization surgeries being performed in elderly patients. Complications leading to reoperation can be associated with significant morbidity and mortality. In this study, we evaluate the impact of perioperative reoperation in elderly patients undergoing lower extremity bypass (LEB).
METHODS: Using the Vascular Quality Initiative database (2003-2018), we examined 20,130 consecutive infrainguinal LEB performed in elderly patients (≥65 years). Cohort frequency matching was used to compare patients who underwent perioperative reoperation versus those who did not using age, indication, urgency, anesthesia type, type of bypass, and VQI frailty variables. Primary endpoints included perioperative mortality, cardiac and respiratory complications, surgical site infection (SSI), and length of stay (LOS). Multivariable regression analysis was performed after excluding patients who underwent perioperative amputation.
RESULTS: In the crude cohort, 2,343 (11.6%) underwent reoperation following infrainguinal LEBs. Indications for reoperation included amputation, thrombosis, bypass revision, bleeding, and infection. In the crude and matched cohorts, reoperation was associated with significantly higher perioperative mortality (5.5% vs. 3.4%), myocardial infarct (6.2% vs. 4.0%), respiratory complication (7.6% vs. 2.7%), and SSI (8.5% vs. 2.6%) (p<.0001). Hospital LOS was significantly longer for reoperation (13.4±15.0 vs. 6.2±6.0 days, p<.001). On multivariable analysis, after excluding patients who underwent perioperative amputation, reoperation was independently associated with increased risk of mortality (aOR=1.7, 95%CI=1.3,2.2), cardiac complication (aOR=1.9, 95%CI=1.6,2.2), respiratory complication (aOR=2.9, 95%CI=2.3,3.7), and SSI (aOR=3.5,95%CI=1.2,1.5) (p<.001).
CONCLUSIONS: Reoperation to treat perioperative complications occurred in up to 12% of elderly patients undergoing LEBs. Reoperation independently predicted more significant risks of perioperative mortality and morbidity and prolonged hospital LOS. Mid-term survival was also significantly lower for patients who underwent reoperation following LEBs.
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