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Home > Vascular Annual Meeting > lamuraglia_significant_perioperative_morbidity

Significant Perioperative Morbidity Accompanies Contemporary Infrainguinal Bypass Surgery: An NSQIP Report

Glenn M. LaMuraglia, Mark F. Conrad, Tom Chung, Matthew Hutter, Christopher J. Kwolek, Michael T. Watkins, David C. Brewster, Robert T. Lancaster, Richard P. Cambria.
Massachusetts General Hospital, Boston, Mass.

OBJECTIVES: A variety of clinical and anatomic factors influence the choice between infrainguinal bypass surgery (BPG) and endovascular procedures (PTA) to treat lower extremity vascular disease. The decision, in part, is dependant on periprocedural outcomes. This study is undertaken to document the contemporary morbidity of infrainguinal BPG.

METHODS: Data from the private sector NSQIP prospective database of CPT codes for all infrainguinal BPG performed between 1/1/05-12/31/06 were analyzed. Study endpoints included death and NSQIP-defined major complications (including graft failure), stratified to systemic vs. operative-site related complications. Potentially associated clinical variables were assessed by univariate methods to create the multivariate models in the results (P, OR).

RESULTS: There were 2404 infrainguinal BPG (infrapopliteal distal anastomosis 42%, prosthetic 29%) with patient demographics: age 67±12, male 66%, diabetes 44%, limb salvage 48%. The 30-day composite mortality/major morbidity was 19.5%. The overall mortality was 2.7% and correlated with: patient age (<.001, 1.056), weight (.007, .988), significant dyspnea (.03, 1.97), dialysis (.003, 5.26), history TIA (.03, 2.43), and bleeding disorder (.02, 2.01). Major complications occurred in 18.7% patients, including 7.4% graft thromboses and 11.7% wound infections. Major systemic complications occurred in 5.9% and correlated to: age (.001, 1.03), history MI (.02, 2.37), dialysis (<.001, 2.52), impaired sensorium (.005, 2.93), and general anesthesia (.04, 1.9). Major operative-site related complications occurred in 15.1% and correlated to: history COPD (.04, 1.40), limb salvage (<.001, 1.71), impaired sensorium (.01, 2.26), non-independent pre-operative functional status (.03, 1.37), and operative time (<.001, 1.002).

CONCLUSIONS: These data of 30-day infrainguinal BPG outcomes identify a significant incidence of major morbidity and mortality in contemporary practice. These results reinforce the precept that stringent indications for BPG should be maintained and, when anatomically feasible, PTA should be considered the initial therapy for infrainguinal arterial reconstruction.
AUTHOR DISCLOSURES: G.M. LaMuraglia, None; M.F. Conrad, None; T. Chung, None; M. Hutter, None; C.J. Kwolek, None; M.T. Watkins, None; D.C. Brewster, None; R.T. Lancaster, None; R.P. Cambria, None.