Trinidad Bradley, Rybin Denis, Doros Gheorghe, Eslami Mohammad, Tan Tze-Woei
Division of Vascular and Endovascular Surgery, University of Arizona Department of Surgery, Banner University Medical Center Tucson, Tucson, Arizona.
Boston University School of Public Health, Boston, Massachusetts.
Int J Angiol. 2019 Jun;28(2):124-129. doi: 10.1055/s-0039-1683898. Epub 2019 Mar 28.
We identified factors that would lead to wound complications after open femoral exposure for endovascular abdominal aortic aneurysm repair (oEVAR). Using the National Surgical Quality Improvement Program dataset (2005-2014), we examined the patients who underwent oEVAR. Patients were stratified on whether they developed postoperative wound complications. Comparisons were made between group with wound complications and those without and adjusted analyses performed to identify variables that independently increased the risk of wound complications. There were 14,868 patients in the study cohort and 2.6% (384 patients) developed wound complications after EVAR. Among those with wound complications, 94% (360 patients) of patients had superficial and deep surgical site infection. Patients who had wound complication were likely to be younger (72.6 vs. 73.7 years old ( = 0.02), functionally dependent (5.4 vs. 2.5%) ( < 0.05), smoker (3 vs. 2.4%, =0.03), female (4 vs. 2.2%), with significantly higher body mass index (31 vs. 28), and more commonly had diabetes (4 vs. 2.4%, < 0.001) or renal failure (12 vs. 3%, < 0.001). Although perioperative survival was similar, patients who had wound complications had significantly longer hospital length of stay (LOS) (7.3 ± 12 vs. 3.4 ± 5 days, < 0.001). Up to 3% patients developed wound complications after open femoral exposure during EVAR with significantly higher LOS and therefore cost utilization.
我们确定了在开放性股动脉暴露下行血管腔内腹主动脉瘤修复术(oEVAR)后导致伤口并发症的因素。利用国家外科质量改进计划数据集(2005 - 2014年),我们对接受oEVAR的患者进行了研究。根据患者是否发生术后伤口并发症进行分层。对有伤口并发症的组和无伤口并发症的组进行比较,并进行校正分析以确定独立增加伤口并发症风险的变量。研究队列中有14868例患者,2.6%(384例患者)在EVAR后发生伤口并发症。在有伤口并发症的患者中,94%(360例患者)发生了浅表和深部手术部位感染。发生伤口并发症的患者可能更年轻(72.6岁对73.7岁,P = 0.02),功能依赖(5.4%对2.5%)(P < 0.05),吸烟(3%对2.4%,P = 0.03),女性(4%对2.2%),体重指数显著更高(31对28),更常见的是患有糖尿病(4%对2.4%,P < 0.001)或肾衰竭(12%对3%,P < 0.001)。尽管围手术期生存率相似,但有伤口并发症的患者住院时间显著更长(7.3±12天对3.4±5天,P < 0.001)。高达3%的患者在EVAR期间开放性股动脉暴露后发生伤口并发症,住院时间显著更长,因此成本更高。