Division of Vascular Surgery, Stanford University, Stanford, CA, USA.
J Vasc Surg. 2011 Aug;54(2):346-51; discussion 351-2. doi: 10.1016/j.jvs.2011.01.030. Epub 2011 Apr 17.
Complications after abdominal aortic aneurysm (AAA) repair resulting in reintervention increase mortality risk, but have not been well studied. Mortality after reintervention is termed failure to rescue and may reflect differences related to quality management of the complication. This study describes the relationship between reoperation and mortality and examines the effect of physician speciality on reintervention rates and failure to rescue after AAA repair.
Data were extracted for 2616 patients who underwent intact AAA repair in 2005 to 2006 from a standard 5% random sample of all Medicare beneficiaries. Patient demographics, comorbidities, hospital characteristics, repair type, and speciality of operating surgeon were collected. Primary outcomes were 30-day reoperation and 30-day mortality. Logistic regression analysis identified characteristics predicting reoperation.
A total of 156 reoperations were required in 142 (4.2%) patients. Early mortality was far more likely for patients requiring reintervention than for those who did not (22.5% vs 1.5%; P < .0001). Of patients requiring reoperation, those requiring two or more interventions had an even higher mortality (54% vs 20%; P = .0007). Despite equivalent reoperation rates between specialities (vascular surgeons, 5.2%; others, 5.6%, P = .67), the mortality after reoperation was nearly half for vascular surgeons compared with other specialities (16.2% vs 32.3%; P = .04). The most common reason for reoperation was arterial complications (35.8%) accounting for the largest difference in mortality between vascular surgeons (30.7%) and other specialities (52.0%).
Postoperative complications requiring reoperation dramatically increase mortality after AAA repair. Despite similar complication rates, vascular surgeons showed lower mortality rates after reoperation.
腹主动脉瘤（AAA）修复术后导致再次干预的并发症会增加死亡风险，但尚未得到充分研究。再次干预后的死亡率被称为抢救失败，可能反映了与并发症质量管理相关的差异。本研究描述了再次手术与死亡率之间的关系，并检查了医师专业对 AAA 修复后再干预率和抢救失败的影响。
从 2005 年至 2006 年所有 Medicare 受益人的标准 5%随机样本中提取了 2616 名接受完整 AAA 修复的患者数据。收集了患者人口统计学、合并症、医院特征、修复类型和手术医生的专业信息。主要结局是 30 天内再次手术和 30 天内死亡率。逻辑回归分析确定了预测再次手术的特征。
共有 156 名患者（142 名患者，占 4.2%）需要进行 156 次再次手术。需要再次干预的患者的早期死亡率远远高于不需要再次干预的患者（22.5%比 1.5%；P<0.0001）。在需要再次手术的患者中，需要进行两次或更多次干预的患者死亡率更高（54%比 20%；P=0.0007）。尽管各专业的再次手术率相当（血管外科医生为 5.2%，其他医生为 5.6%，P=0.67），但血管外科医生的术后死亡率几乎是其他专业的一半（16.2%比 32.3%；P=0.04）。再次手术最常见的原因是动脉并发症（35.8%），这导致血管外科医生（30.7%）和其他专业医生（52.0%）之间的死亡率差异最大。
需要再次手术的术后并发症大大增加了 AAA 修复后的死亡率。尽管并发症发生率相似，但血管外科医生在再次手术后的死亡率较低。
