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Home > Vascular Annual Meeting > RR23. Infectious Complications After Elective...

RR23. Infectious Complications After Elective Open AAA Repair: Impact of Leapfrog Volume Criteria, Hospital Characteristics, and Patient Demographics

Todd R. Vogel, Viktor Y. Dombrovskiy, Jeffrey L. Carson, Paul B. Haser, Stephen F. Lowry, Alan M. Graham
UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ

OBJECTIVES: Nosocomial infections after surgery are associated with increased morbidity, mortality, length of hospital stay, and healthcare costs. We analyzed hospital and patient characteristics associated with infectious complications after elective open abdominal aortic aneurysm (AAA) repair.

METHODS: The Nationwide Inpatient Sample 2002-2006 was analyzed for elective non-ruptured open AAA repairs with respect to nosocomial infectious complications including pneumonia (PNA), urinary tract infections (UTI), postoperative sepsis, surgical site infections (SSI), and C. difficile colitis. Patient and hospital characteristics as well as Leapfrog volume criteria were evaluated and their associations with nosocomial infections were assessed.

RESULTS: Open AAA repairs (46,323) had an overall infectious complication rate of 12.02%. PNA (6.62%) represented the greatest postoperative infection followed by UTI (2.38%), sepsis (1.85%), and wound infections (1.08%). Infection rates were associated with increasing age (p<0.001), black race (p=0.04 versus whites), and female gender (p<0.001), but not associated with hospital teaching status (p=0.33) or geographic location (p=0.18). A trend of decreasing postoperative infectious rates after open AAA repair was associated with increasing hospital bed size (p=0.019). Hospitals meeting Leapfrog volume criteria had lower overall rates of infectious complications (p=0.012), including PNA (p=0.0005), and sepsis (p=0.041). Hospitals not meeting Leapfrog criteria were 1.18 as likely to develop PNA (95% CI = 1.08-1.30) and 1.16 as likely to develop sepsis (95% CI = 1.01-1.34). After adjustment for age, race, gender, and comorbidities, octogenarians (OR=1.63; 95% CI=1.47-1.80), blacks (OR=1.43; 95% CI=1.17-1.75), and females (OR=1.38; 95% CI=1.27-1.49) remained more likely to develop postoperative infectious complications.

CONCLUSIONS: Infectious complications after elective open AAA surgery occur at a significant rate and are more common in females, blacks, and the aged. Smaller hospital size was associated with higher infectious complications after open AAA repair. Further implementation of Leapfrog volume standards may prevent numerous infectious complications after elective open AAA repair.

AUTHOR DISCLOSURES: T.R. Vogel, American Heart Association; V.Y. Dombrovskiy, None; J.L. Carson, National Heart, Lung, and Blood Institute; P.B. Haser, None; S.F. Lowry, National Institute of General Medical Sciences; A.M. Graham, None.