RESUMEN
PURPOSE: The widespread adoption of endovascular aneurysm repair (EVAR) as preferred treatment modality for abdominal aortic aneurysm (AAA) has enlarged the number of patients needing open surgical conversion (OSC). The relationship between adherence to Instructions For Use (IFU) and EVAR long-term outcomes remains controversial. The aim of this study is to compare preoperative differences and postoperative outcomes between EVAR patients not adjusted to IFU and adjusted to IFU who underwent OSC. METHODS: This multicenter retrospective study reviewed 33 explanted EVARs between January 2003 and December 2019 at 14 Vascular Units. Patients were included if OSC occurred >30 days after implantation and excluded if explantation was performed to treat an endograft infection, aortic dissection, or traumatic transections. Variables analyzed included baseline characteristics, adherence to IFU, implant and explant procedural details, secondary reinterventions, and postoperative outcomes. RESULTS: Fifteen explanted patients (15/33, 45.5%) were identified not accomplished to IFU (out-IFU) at initial EVAR vs 18 explanted patients adjusted (in-IFU). During follow-up, a mean of 1.73±1.2 secondary reinterventions were performed, with more type I endoleaks treated in the subgroup out-IFU: 16.7% vs 6.3% in-IFU patients and more type III endoleaks (8.3% vs 0%). Patients out-IFU had shorter mean interval from implant to explant: 47.60±28.8 months vs 71.17±48. Type II endoleak was the most frequent indication for explantation. Low-flow endoleaks (types II, IV, V) account for 44% of indications for OSC in subgroup of patients in-IFU, compared with 13.3% in patients out-IFU and high-flow endoleaks (types I and III) were the main indication for patients out-IFU (33.3% vs 16.7% in-IFU). Total endograft explantation was performed in 57.5% of cases (19/33) and more suprarenal clamping was required in the subgroup out-IFU. Overall, 30-day mortality rate was 12.1% (4/33): 20% for patients out-IFU and 5.6% in-IFU. CONCLUSIONS: In our experience, type II endoleak is the most common indication for conversion and differences have been found between patients treated outside IFU with explantation taking place earlier during follow-up, mainly due to high-flow endoleaks and with higher mortality in comparison with patients adjusted to IFU. Ongoing research is required to delve into these differences.
Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Endofuga/etiología , Endofuga/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Reparación Endovascular de Aneurismas , Procedimientos Endovasculares/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Factores de RiesgoRESUMEN
BACKGROUND: To compare the incidence of surgical site infections (SSIs) before and after the implementation of a bundle of care called "Zero Surgical Site Infection." Secondary goals included estimating measures of association and their potential impact, determining care management indicators in vascular surgery, and evaluating the level of compliance with the bundle. METHODS: This is a prospective observational study with a historic control group. The bundle included (1) removal of body hair with clippers; (2) preoperative showering with chlorhexidine soap; (3) preparation of the surgical field with alcoholic chlorhexidine 2%; (4) adequacy of antimicrobial prophylaxis; (5) intraoperative and (6) postoperative glycemic and central temperature control. Student's t-test and chi-squared test were performed. Relative risk, attributable risk, number needed to treat, and preventable fraction were used as association and impact measures. RESULTS: In total, 192 patients were included. The overall incidence of SSI was 8.85%; the preventive fraction was 59.1%. The rate of incidence of SSI for clean surgery was reduced from 4.9% to 0% (P = 0.127), whereas the average hospital stay decreased from 22.38 to 13.70 days (P = 0.002). Concerning contaminated surgery, significant differences were found in the rate of incidence of SSI (33.3% vs. 13.9%, P = 0.035). Compliance with the bundle of preoperative and intraoperative measures exceeded 95% and almost reached 50%, respectively. Compliance with the bundle of postoperative measures reached 25%. CONCLUSIONS: This bundle has demonstrated to be effective in reducing the incidence of SSI in vascular surgery. The publication of these initial results should encourage the implementation of this bundle at national level.
Asunto(s)
Control de Infecciones/métodos , Paquetes de Atención al Paciente , Evaluación de Procesos, Atención de Salud , Infección de la Herida Quirúrgica/prevención & control , Procedimientos Quirúrgicos Vasculares/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Adhesión a Directriz , Humanos , Incidencia , Tiempo de Internación , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Factores de Riesgo , España/epidemiología , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/microbiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Fístula Intestinal/etiología , Neoplasias del Recto/cirugía , Complicaciones Posoperatorias/cirugíaRESUMEN
No disponible