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 A Population-Level Analysis: The Incidence And Factors Associated With Aortic Graft Infection

Todd R Vogel, Rebecca G. Symons, David R Flum.
University of Washington, Seattle, WA.

OBJECTIVES: The reported rate of abdominal aortic graft infections (AGI) is low but its incidence and associated factors have not been evaluated on a population level. We hypothesized that AGI occurs more often in patients with periprocedural nosocomial infections (NI) and less often after endovascular repair (EVAR).

METHODS: A retrospective cohort study of all patients undergoing aortic surgery (1987-2005) in Washington State using hospital discharge data (CHARS). NI was defined as pneumonia (PNA), urinary tract infections (UTI), blood stream septicemia (BSI), and/or surgical site infection (SSI) at the in index admission. Readmissions and reintervention for graft infections were used to define AGI and we excluded those with a diagnostic code of renal failure or those who appeared to have dialysis grafts.

RESULTS: 13,902 patients (mean age 71.3 ± 8.8, 90.8% male) underwent abdominal aortic surgery (12,626 open, 1,276 EVAR). The cumulative rate of AIG in the cohort was 0.44%. The 2-year rate of AGI was 0.19% among open vs. 0.16% in EVAR (p=0.75) and 0.2% in both elective and non-elective patients. Open procedures had greater rates of PNA (11.1% vs. 2.4%, p<0.001), BSI (1.6%vs.0.7%, p<0.01), SSI (0.5%vs.0%, p<0.012) compared to EVAR. The 2-year rate of AGI was higher after any index NI (0.33% vs. 0.17%, p=0.16), but was particularly associated with SSI. 2-year rates of AGI were higher for PNA (0.35% vs. 0.18%, p=0.16), BSI (0.93%vs.0.18%, p=0.014), and SSI (1.61% vs. 0.19%, p=0.01) than for patients without those infections. The median time to AGI was 3.0 years and presented earlier if NI or emergency surgery occurred (1.4y vs.3.0y; 1.48y vs. 3.64y). This risk was highest in the first postoperative year (32% of all AGI occurred in year 1). Interestingly, no 1-year AGI was seen in the EVAR group.

CONCLUSIONS: The incidence of AGI was low, presented most commonly in the first post-operative year and was similar among patients undergoing open and endovascular AAA. NI and emergency surgery had an earlier onset of AGI. The 2-year rate of AGI was higher among patients with periprocedural NI infection, particularly SSI. These data may be helpful in directing surveillance programs aimed for detection and intervention in patients with AIG.