Shorter duration of femoral-popliteal bypass is associated with decreased surgical site infection and shorter hospital length of stay

Tze Woei Tan, Jeffrey A. Kalish, Naomi M. Hamburg, Denis Rybin, Gheorghe Doros, Robert T. Eberhardt, Alik Farber

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

Background: 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. Study Design: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)512-518
Number of pages7
JournalJournal of the American College of Surgeons
Volume215
Issue number4
DOIs
StatePublished - Oct 2012
Externally publishedYes

Keywords

  • ACS
  • American College of Surgeons
  • BMI
  • body mass index
  • femoral-popliteal bypass
  • FPB
  • length of stay
  • LOS
  • means ratio
  • MR
  • odds ratio
  • OR
  • Q
  • quartile
  • SSI
  • surgical site infection

ASJC Scopus subject areas

  • Surgery

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