Patient and procedure-related risk factors for adverse events after infrainguinal bypass.

BACKGROUND: Current medical practice urges individual health care facilities and medical professionals to obtain and provide detailed insight in quality of care with the possibility of comparing data between institutions. Adverse event (AE) analysis serves as a mainstay in quality assessment in vascular surgery, but the comparison of AE data between facilities can be complex. The aim of the present study was to assess independent risk factors for AE occurrence: patient, disease and operation characteristics besides general differences between health care facilities. METHODS: All AEs after infrainguinal bypass graft procedures (BGPs) in three health care facilities in the Netherlands were evaluated. AEs were defined identically in the facilities. RESULTS: Of 601 BGPs performed, 662 AEs were registered. Independent predictors of AEs were female gender (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.39-3.26; P < .01), age >or=60 years (OR, 0.57; 95% CI, 0.34-0.95; P = .03), American Society of Anesthesiologists classification 3-4 (OR, 1.79; 95% CI, 1.01-3.17; P = .05), comorbidities of pulmonary disease (OR, 2.99; 95% CI, 1.67-5.34; P < .01) and diabetes mellitus (OR, 2.49; 95% CI, 1.58-3.94; P < .01), distal anastomosis level at below knee femoropopliteal BGP (OR, 2.01; 95% CI, 1.26-3.22; P < .01), femorotibial BGP (OR, 2.40; 95% CI, 1.37-4.19; P < .01), and popliteopedal BGP (OR, 92.39; 95% CI, 11.13-766.98; P < .01). One health care facility had significantly fewer AEs than the other two (OR, 0.21; 95% CI, 0.13-0.35; P < .01). CONCLUSION: Age, gender, comorbidity, and type of surgery are all independent predictors of AE occurrence in vascular surgery. After adjustment for differences in these factors, one health care facility still had lower AE occurrence, which needs to be examined further.

Wound complications at the groin after peripheral arterial surgery sparing the lymphatic tissue: a double-blind randomized clinical trial.

BACKGROUND: The groin incision after arterial reconstructive surgery is most likely at risk for infectious or lymphatic wound complications. Theoretically; sparing lymphatic tissue by a lateral approach to the femoral artery should minimize these. The aim of this study was to assess the incidence of wound complications after the lateral versus the direct approach of the common femoral artery. METHODS: The study population included all patients who underwent an exploration of the common femoral artery between May 2002 and December 2005. RESULTS: After 6 weeks, no statistical differences in the occurrence of wound complications could be shown. A wound infection was present after 6 weeks in 6.1% in the direct group versus 6.0% in the lateral group. Lymphorrhea was persistent in 3.1% in the direct group versus 5.0% in the lateral group. CONCLUSIONS: Using a lateral vertical incision for the approach of the common femoral artery did not decrease the incidence of postoperative wound complications.

The incidence of unplanned returns to the operating room after peripheral arterial bypass surgery and its value as indicator of quality of care.

BACKGROUND: In recent years, a growing need has arisen to define possible indicators of quality of care. METHODS: To examine whether unplanned return to the operating room within 30 days after the initial procedure could serve as an indicator to assess quality of care in peripheral arterial bypass surgery, all bypass procedures performed between January 1996 and January 2004 were evaluated. Data were obtained from a prospectively kept hospital registration system. RESULTS: A total of 607 consecutive procedures were performed in 468 patients. The overall unexpected return to the operating room rate was 11.2%. Patients requiring peripheral arterial bypass surgery for critical ischemia with gangrene were significantly more at risk for an unplanned reoperation (20.2%) than patients with disabling claudication (2.1%) (P < .0001). Patients requiring femorocrural bypass surgery (24.2%) were also more at risk than patients with a suprageniculate bypass procedure (5.2%) (P < .0001). CONCLUSIONS: Unplanned return to the operating room within 30 days after the initial operation can be a useful indicator of quality of care after peripheral arterial bypass surgery. However, a prospective, well-defined registration system to collect all data is essential. Furthermore, the severity of peripheral arterial disease and the type of procedure performed should be taken into account.

Factors associated with perioperative complications and long-term results after pulmonary resection for primary carcinoma of the lung.

OBJECTIVE: The aim of this study was to describe perioperative morbidity and mortality of patients presenting with resectable lung cancer and to investigate the long-term survival. METHODS: We reviewed the records of 344 patients who underwent lung resection for bronchogenic carcinoma. Follow-up information was obtained from visits to the outpatient clinic. RESULTS: Between January 1991 and December 1995 there were 263 males and 81 females included with a mean age of 65.7 years. One hundred and eight (31%) patients underwent a pneumonectomy, 159 (46%) a lobectomy, 43 (13%) a bilobectomy, four (1%) a segmental resection and 30 (9%) an explorative thoracotomy. A total of 341 complications occurred. The 30 day mortality rate was 7.9% (27 patients). Patients with a low FEV1% and older patients have a higher risk of mortality within 30 days. Postoperative myocardial infarction and pneumonia were associated with an increase in 30 day mortality. The median survival was 3.6 years for stage I, 1.9 years for stage II, 1.0 years for stage IIIa, 0.9 years for stage IIIb and 0.9 years for stage IV. Prognostic factors for the long-term survival included stage, pneumonectomy, percentage FEV1 <70, and large cell carcinoma. CONCLUSIONS: Pulmonary resection can be performed at an acceptable risk. Critical reviewing of our results made it possible to make recommendations for improvements.