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PC076. Cardiac Care Halo Effect on Postoperative Myocardial Infarction Outcomes in Vascular Surgery Patients
176S Abstracts
Secondary outcomes included myocardial infarction, wound infections, and postoperative renal insufficiency. Multivariable models were used to determine factors independently associated with blood transfusion, wound infection, postoperative renal insufficiency, and MI. The Cuzick test was used to detect changes in the rate of blood transfusion over time. Results: A total of 121,284 patients underwent vascular surgery in the cohort: 8078 AAA, 25,867 EVAR, 7,229 CFEA, 14,555 LEB, and 65,555 CEA. Perioperative transfusion occurred in 15,619 (13%): 5539 AAA (68.6%), 3719 EVAR (14.4%), 976 CFEA (13.5%), 4045 LEB (27.8%), and 1340 CEA (2%). The rate of transfusion decreased over the years studied (z 7.86; P < .001), as did the average number of units of blood transfused (z 10.63; P < .001). As compared to CEA, open AAA (OR, 190.0; 95% CI, 175.2-206), EVAR (OR, 9.21; 95% CI, 8.60-9.87), CFEA (OR, 6.04; 95% CI, 5.51-6.62), and LEB (OR, 12.70; 95% CI, 11.8-13.6) were independently associated with transfusion events, as were a history of a bleeding disorder (OR,1.50; 95% CI, 1.42-1.57) and platelet abnormalities (OR,1.35; 95% CI, 1.19-1.54). White race (OR, 0.79; 95% CI, 0.76-0.84) was protective. The rates of wound infections (z 5.15; P < .001) and renal insufficiency (z 3.81; P < .001) decreased over the period of the study, while MI rates increased (z 11.07; P < .001). Blood transfusion was an independent risk factor for all three adverse outcomes. Conclusions: The rate of blood transfusion for major vascular procedures has decreased over the course of several years in hospitals participating in NSQIP. The rates of myocardial infarction have increased, and the rates of wound infection have decreased. The relationship between blood transfusion, adverse outcomes, and the rate of myocardial infarction should be further studied to best benefit patients undergoing vascular surgery.
JOURNAL OF VASCULAR SURGERY June Supplement 2016
goal of this study was to determine if hospital differences in postoperative mortality after MI in vascular patients was associated with a hospital’s overall quality of cardiac care. Methods: The Healthcare Utilization Project State Inpatient Database (HCUP SID) for Florida was queried using ICD-9-CM codes to include patients who underwent open or endovascular AAA repair, a lower extremity (LE) amputation, or an infrainguinal bypass. Each hospital’s quality of cardiac care was evaluated using 30-day post-MI mortality rates for all patients admitted for MI, published in Medicare’s Hospital Compare database. Rates of failure to rescue (FTR) after postoperative MI were determined using data from those patients who developed postoperative MI and subsequently died, and is a common measure of quality care. Linear regression was performed to compare FTR rates to 30-day postMI mortality rates. Results: A total of 40,915 patients met inclusion criteria. The rate of MI for each AAA repair, LE amputation, and infrainguinal bypass was found to be 1.16%, 2.14%, and 1.93%, respectively. These rates were in accordance with previously published national rates. The mean FTR rate after postoperative MI for all combined procedures was 16.7% (IQR, 0%-33.3%). A positive relationship was seen when comparing a hospital’s 30-day post-MI mortality rate and postoperative FTR for patients undergoing vascular procedures at that hospital (coef ¼ *0.0436; P ¼ .023; Fig). Conclusions: These results indicate that in the case of postoperative MI, the quality of cardiac care provided on a hospital-level can be protective for patients undergoing vascular surgery. Further investigation into the determinants of this “halo effect” may inform hospitals on how to improve surgical outcomes in patients with medical complications. Importantly, these data suggest that hospital-level quality improvement can influence both medical and surgical patient outcomes.
Author Disclosures: S. M. Damrauer: Nothing to disclose; B. Ecker: Nothing to disclose; R. M. Fairman: Nothing to disclose; J. D. Glaser: Nothing to disclose; G. Karakousis: AmGen and Castle Biosciences: consulting fees (eg, advisory boards). PC076. PC076 Cardiac Care Halo Effect on Postoperative Myocardial Infarction Outcomes in Vascular Surgery Patients Elizabeth M. Grindstaff, MD1, Yoshiki Ezure, MD2, Elizabeth C. He, MD2, Anai N. Kothari, MD2, Paul C. Kuo, MD2, Bernadette Aulivola, MD2. 1Loyola University Medical Center, Oak Park, Ill; 2Loyola University Medical Center, Maywood, Ill Objectives: Many vascular procedures are considered high cardiac risk, with myocardial infarction (MI) being a relatively common postoperative complication. While rates of postoperative MI vary by procedure, they are stable across the nation. However, mortality after postoperative MI varies by hospital. Similarly, 30-day mortality rates for nonsurgical patients vary across centers. The
Fig.
Author Disclosures: B. Aulivola: Nothing to disclose; Y. Ezure: Nothing to disclose; E. M. Grindstaff: Nothing to disclose; E. He: Nothing to disclose; A. Kothari: Nothing to disclose; P. Kuo: Nothing to disclose.
Secondary outcomes included myocardial infarction, wound infections, and postoperative renal insufficiency. Multivariable models were used to determine factors independently associated with blood transfusion, wound infection, postoperative renal insufficiency, and MI. The Cuzick test was used to detect changes in the rate of blood transfusion over time. Results: A total of 121,284 patients underwent vascular surgery in the cohort: 8078 AAA, 25,867 EVAR, 7,229 CFEA, 14,555 LEB, and 65,555 CEA. Perioperative transfusion occurred in 15,619 (13%): 5539 AAA (68.6%), 3719 EVAR (14.4%), 976 CFEA (13.5%), 4045 LEB (27.8%), and 1340 CEA (2%). The rate of transfusion decreased over the years studied (z 7.86; P < .001), as did the average number of units of blood transfused (z 10.63; P < .001). As compared to CEA, open AAA (OR, 190.0; 95% CI, 175.2-206), EVAR (OR, 9.21; 95% CI, 8.60-9.87), CFEA (OR, 6.04; 95% CI, 5.51-6.62), and LEB (OR, 12.70; 95% CI, 11.8-13.6) were independently associated with transfusion events, as were a history of a bleeding disorder (OR,1.50; 95% CI, 1.42-1.57) and platelet abnormalities (OR,1.35; 95% CI, 1.19-1.54). White race (OR, 0.79; 95% CI, 0.76-0.84) was protective. The rates of wound infections (z 5.15; P < .001) and renal insufficiency (z 3.81; P < .001) decreased over the period of the study, while MI rates increased (z 11.07; P < .001). Blood transfusion was an independent risk factor for all three adverse outcomes. Conclusions: The rate of blood transfusion for major vascular procedures has decreased over the course of several years in hospitals participating in NSQIP. The rates of myocardial infarction have increased, and the rates of wound infection have decreased. The relationship between blood transfusion, adverse outcomes, and the rate of myocardial infarction should be further studied to best benefit patients undergoing vascular surgery.
JOURNAL OF VASCULAR SURGERY June Supplement 2016
goal of this study was to determine if hospital differences in postoperative mortality after MI in vascular patients was associated with a hospital’s overall quality of cardiac care. Methods: The Healthcare Utilization Project State Inpatient Database (HCUP SID) for Florida was queried using ICD-9-CM codes to include patients who underwent open or endovascular AAA repair, a lower extremity (LE) amputation, or an infrainguinal bypass. Each hospital’s quality of cardiac care was evaluated using 30-day post-MI mortality rates for all patients admitted for MI, published in Medicare’s Hospital Compare database. Rates of failure to rescue (FTR) after postoperative MI were determined using data from those patients who developed postoperative MI and subsequently died, and is a common measure of quality care. Linear regression was performed to compare FTR rates to 30-day postMI mortality rates. Results: A total of 40,915 patients met inclusion criteria. The rate of MI for each AAA repair, LE amputation, and infrainguinal bypass was found to be 1.16%, 2.14%, and 1.93%, respectively. These rates were in accordance with previously published national rates. The mean FTR rate after postoperative MI for all combined procedures was 16.7% (IQR, 0%-33.3%). A positive relationship was seen when comparing a hospital’s 30-day post-MI mortality rate and postoperative FTR for patients undergoing vascular procedures at that hospital (coef ¼ *0.0436; P ¼ .023; Fig). Conclusions: These results indicate that in the case of postoperative MI, the quality of cardiac care provided on a hospital-level can be protective for patients undergoing vascular surgery. Further investigation into the determinants of this “halo effect” may inform hospitals on how to improve surgical outcomes in patients with medical complications. Importantly, these data suggest that hospital-level quality improvement can influence both medical and surgical patient outcomes.
Author Disclosures: S. M. Damrauer: Nothing to disclose; B. Ecker: Nothing to disclose; R. M. Fairman: Nothing to disclose; J. D. Glaser: Nothing to disclose; G. Karakousis: AmGen and Castle Biosciences: consulting fees (eg, advisory boards). PC076. PC076 Cardiac Care Halo Effect on Postoperative Myocardial Infarction Outcomes in Vascular Surgery Patients Elizabeth M. Grindstaff, MD1, Yoshiki Ezure, MD2, Elizabeth C. He, MD2, Anai N. Kothari, MD2, Paul C. Kuo, MD2, Bernadette Aulivola, MD2. 1Loyola University Medical Center, Oak Park, Ill; 2Loyola University Medical Center, Maywood, Ill Objectives: Many vascular procedures are considered high cardiac risk, with myocardial infarction (MI) being a relatively common postoperative complication. While rates of postoperative MI vary by procedure, they are stable across the nation. However, mortality after postoperative MI varies by hospital. Similarly, 30-day mortality rates for nonsurgical patients vary across centers. The
Fig.
Author Disclosures: B. Aulivola: Nothing to disclose; Y. Ezure: Nothing to disclose; E. M. Grindstaff: Nothing to disclose; E. He: Nothing to disclose; A. Kothari: Nothing to disclose; P. Kuo: Nothing to disclose.