Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery

Pronovost, Peter J.; Garrett, Elizabeth; Dorman, Todd; Jenckes, Mollie W.; Webb, Thomas H.; Breslow, Michael J.; Rosenfeld, Brian A.; Bass, Eric B.

doi:10.1007/s004230100216

Cited by 37 publications

(21 citation statements)

References 35 publications

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“…[2][3][4] AKI is also a severe complication in general surgery, increasing mortality, morbidity and hospital costs. 5,6 Studies evaluating kidney function in abdominal aorta surgery demonstrated both glomerular (albuminuria) and tubular (increased urinary NAG-creatinine ratio) injury in up to 96% of the subjects, although only 22% had RIFLE-defined acute kidney injury, and a worse short-term (30 days) and long-term (10 years) survival of the AAA (abdominal aortic aneurysm) surgery patients who experienced a temporary AKI, even if their renal function completely recovered. 7,8 The aim of our study was to evaluate the prevalence of AKI, its association with the short-term (within 30-days postoperatively) and long-term (1 year postoperatively) prognosis in a cohort of patients with severe peripheral artery disease (PAD) undergoing surgical procedures of lower extremity revascularization or amputation and the most important comorbidities associated with AKI development.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in peripheral arterial surgery patients: a cohort study

Schiller¹,

Mihaescu²,

Timar³

et al. 2013

Renal Failure

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Purpose: The aim of the study was to evaluate the prevalence of acute kidney injury (AKI) in a cohort of surgically treated patients with peripheral artery disease (PAD) and its association with the short-term and long-term outcome. Materials and methods: We conducted a retrospective cohort study on all the consecutive PAD inpatients in 2008. Data on the patients' demographic characteristics, medical history, treatment, outcome and laboratory tests measurements were retrieved from the medical records. Results: We analyzed 166 patients (71.6% males, mean age 63.2 years AE SD 10.7 years) and found an AKI prevalence of 12.7%. The AKI patients' group had more chronic kidney disease (CKD) (23.8% vs. 6.2%, p ¼ 0.005), diabetes mellitus (DM) (61.9% vs. 33.1%, p ¼ 0.011) and a higher length of hospital stay (19.48 vs. 15.42 days, p ¼ 0.047). At one year, the mortality was 33.3% in the AKI group compared to 1.3% in non-AKI group, with a strong association between AKI and death (OR ¼ 35.7; 95%CI ¼ 6.7 to 189) and AKI and major cardiovascular events (OR ¼ 29

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Section: Introductionmentioning

confidence: 99%

Acute kidney injury in peripheral arterial surgery patients: a cohort study

Schiller¹,

Mihaescu²,

Timar³

et al. 2013

Renal Failure

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“…Compared with patients who are successfully extubated, patients who are reintubated have worse clinical outcomes, including prolonged lengths of stay (LOSs) in the intensive care unit (ICU) and hospital, and increased mortality [1-4]. The cause for the increased mortality is not known but has been hypothesized to be either a delay in reintubation or a complication of the endotracheal intubation itself.…”

Section: Introductionmentioning

confidence: 99%

The outcome of extubation failure in a community hospital intensive care unit: a cohort study

et al. 2004

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IntroductionExtubation failure has been associated with poor intensive care unit (ICU) and hospital outcomes in tertiary care medical centers. Given the large proportion of critical care delivered in the community setting, our purpose was to determine the impact of extubation failure on patient outcomes in a community hospital ICU.MethodsA retrospective cohort study was performed using data gathered in a 16-bed medical/surgical ICU in a community hospital. During 30 months, all patients with acute respiratory failure admitted to the ICU were included in the source population if they were mechanically ventilated by endotracheal tube for more than 12 hours. Extubation failure was defined as reinstitution of mechanical ventilation within 72 hours (n = 60), and the control cohort included patients who were successfully extubated at 72 hours (n = 93).ResultsThe primary outcome was total ICU length of stay after the initial extubation. Secondary outcomes were total hospital length of stay after the initial extubation, ICU mortality, hospital mortality, and total hospital cost. Patient groups were similar in terms of age, sex, and severity of illness, as assessed using admission Acute Physiology and Chronic Health Evaluation II score (P > 0.05). Both ICU (1.0 versus 10 days; P < 0.01) and hospital length of stay (6.0 versus 17 days; P < 0.01) after initial extubation were significantly longer in reintubated patients. ICU mortality was significantly higher in patients who failed extubation (odds ratio = 12.2, 95% confidence interval [CI] = 1.5–101; P < 0.05), but there was no significant difference in hospital mortality (odds ratio = 2.1, 95% CI = 0.8–5.4; P < 0.15). Total hospital costs (estimated from direct and indirect charges) were significantly increased by a mean of US$33,926 (95% CI = US$22,573–45,280; P < 0.01).ConclusionExtubation failure in a community hospital is univariately associated with prolonged inpatient care and significantly increased cost. Corroborating data from tertiary care centers, these adverse outcomes highlight the importance of accurate predictors of extubation outcome.

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“…As the data are primarily used for billing and administrative purposes, we could not quantify the severity of illness of patients. We identified complications associated with surgery using ICD-9-CM codes (Table e1) [10, 11]. Due to potential variation in use of the “present on admission” indicator, we chose not to use this indicator in generating complications, which is consistent with other studies [12].…”

Section: Methodsmentioning

confidence: 99%

Association between age and use of intensive care among surgical Medicare beneficiaries

Wunsch

Gershengorn

Guerra

et al. 2013

Journal of Critical Care

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Purpose To determine the role age plays in use of intensive care for patients who have major surgery. Materials and Methods Retrospective cohort study examining the association between age and admission to an intensive care unit (ICU) for all Medicare beneficiaries aged 65 or older who had a hospitalization for one of five surgical procedures: esophagectomy, cystectomy, pancreaticoduodenectomy (PD), elective open abdominal aortic aneurysm repair (open AAA), and elective endovascular AAA repair (endo AAA) from 2004–08. The primary outcome was admission to an ICU. Secondary outcomes were complications and hospital mortality. We used multi-level mixed-effects logistic regression to adjust for other patient and hospital-level factors associated with each outcome. Results The percentage of hospitalized patients admitted to ICU ranged from 41.3% for endo AAA to 81.5% for open AAA. In-hospital mortality also varied, from 1.1% for endo AAA to 6.8% for esophagectomy. After adjusting for other factors, age was associated with admission to ICU for cystectomy (Adjusted Odds Ratio (AOR) 1.56 (95% CI 1.36–1.78) for age 80–84+; 2.25 (1.85–2.75) age 85+ compared with age 65–69), PD (AOR 1.26 (1.06–1.50) age 80–84; 1.49 (1.11–1.99) age 85+) and esophagectomy (AOR 1.26 (1.02–1.55) age 80–84; 1.28 (0.91–1.80) age 85+). Age was not associated with use of intensive care for open or endo AAA. Older age was associated with increases in complication rates and in-hospital mortality for all five surgical procedures. Conclusions The association between age and use of intensive care was procedure-specific. Complication rates and in-hospital mortality increased with age for all five surgical procedures.

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Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery

Cited by 37 publications

References 35 publications

Acute kidney injury in peripheral arterial surgery patients: a cohort study

Acute kidney injury in peripheral arterial surgery patients: a cohort study

The outcome of extubation failure in a community hospital intensive care unit: a cohort study

Association between age and use of intensive care among surgical Medicare beneficiaries

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