Boston University Medical Center/Boston University School of Medicine, Boston, MA 02118, USA.
J Am Coll Surg. 2012 Oct;215(4):512-8. doi: 10.1016/j.jamcollsurg.2012.06.007. Epub 2012 Jul 21.
Duration of femoral-popliteal bypass is based on multiple patient-specific, system-specific, and surgeon-specific factors, and is subject to considerable variability. We hypothesized that shorter operative duration is associated with improved outcomes and might represent a potential quality-improvement measure.
Patients who underwent primary femoral-popliteal bypass with autogenous vein between 2005 and 2009 were identified from the American College of Surgeons NSQIP dataset using ICD-9 codes. Operative duration quartiles (Q) were determined (Q1: ≤149 minutes, Q2: 150 to 192 minutes, Q3: 193 to 248 minutes; and Q4: ≥249 minutes). Perioperative outcomes included mortality, surgical site infection, cardiopulmonary complications, and length of hospital stay. Relevant patient-specific and system-specific confounders, including age, body mass index, smoking, diabetes, end-stage renal disease, indication, American Society of Anesthesiologists' class, type of anesthesia, intraoperative transfusion, nonoperative time in the operating room, and participation of a trainee during the procedure, were adjusted for using multivariable regression.
There were 2,644 femoral-popliteal bypass procedures in our study. Mean age was 65.9 years and 62% of patients were male. Longer duration of surgery was associated with increased perioperative surgical site infection (Q1: 6.3%; Q2: 9.0%; Q3: 10.1%; and Q4: 13.9%; p < 0.001) and longer length of stay (5.4 ± 6.8 days; 6.1 ± 6.7 days; 7.0 ± 11.3 days; 8.1 ± 8.0 days, respectively; p < 0.001). In multivariable analysis, longer operative duration was independently associated with higher surgical site infection and longer hospital length of stay. Operative duration of ≥260 minutes increased the risk of surgical site infection by 50% compared with operative time of 150 minutes.
Longer duration of femoral-popliteal bypass with autogenous vein was associated with a significantly higher risk of perioperative surgical site infection and longer hospital length of stay. Surgeon-specific parameters that lead to faster operative time might lead to improved clinical outcomes and more efficient hospital resource use.
股腘旁路的持续时间取决于多个患者特异性、系统特异性和外科医生特异性因素，并且存在相当大的可变性。我们假设较短的手术时间与改善的结果相关，并且可能代表一种潜在的质量改进措施。
使用 ICD-9 代码从美国外科医师学会 NSQIP 数据集中确定了 2005 年至 2009 年期间接受自体静脉股腘旁路的患者。确定了手术时间四分位数（Q）（Q1：≤149 分钟，Q2：150 至 192 分钟，Q3：193 至 248 分钟；Q4：≥249 分钟）。围手术期结果包括死亡率、手术部位感染、心肺并发症和住院时间。调整了相关的患者特异性和系统特异性混杂因素，包括年龄、体重指数、吸烟、糖尿病、终末期肾病、适应证、美国麻醉师协会分类、麻醉类型、术中输血、手术室非手术时间和手术过程中接受培训的人员，使用多变量回归。
在我们的研究中，有 2644 例股腘旁路手术。平均年龄为 65.9 岁，62%的患者为男性。手术时间延长与围手术期手术部位感染增加有关（Q1：6.3%；Q2：9.0%；Q3：10.1%；Q4：13.9%；p<0.001）和住院时间延长（5.4±6.8 天；6.1±6.7 天；7.0±11.3 天；8.1±8.0 天，p<0.001）。多变量分析表明，手术时间延长与手术部位感染和住院时间延长独立相关。与手术时间为 150 分钟相比，手术时间≥260 分钟使手术部位感染的风险增加 50%。
自体静脉股腘旁路的持续时间较长与围手术期手术部位感染和住院时间延长的风险显著增加相关。导致手术时间更快的外科医生特异性参数可能会导致改善的临床结果和更有效的医院资源利用。
