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In-hospital versus postdischarge major adverse events within 30 days following lower extremity revascularization.
J Vasc Surg. 2019 02; 69(2):482-489.JV

Abstract

OBJECTIVE

Studies using hospital discharge data likely underestimate postoperative morbidity and mortality after lower extremity revascularization because they fail to capture postdischarge events. However, the degree of underestimation and the timing of postdischarge complications are not well-characterized.

METHODS

We used the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted vascular databases from 2011 to 2015 to tabulate 30-day adverse events (in hospital and after discharge) for lower extremity bypass (LEB) and percutaneous vascular interventions (PVIs) performed for claudication and chronic limb-threatening ischemia (CLTI).

RESULTS

A total of 14,125 patients underwent lower extremity revascularization, 8909 patients (63%) with LEB and 5216 (37%) with PVI. For CLTI, total 30-day mortality was similar between PVI and LEB (2.3% vs 2.1%; P = .61), but in-hospital deaths only accounted for 43% of PVI mortality and only 65% of LEB mortality (P ≤ .001). Major adverse cardiac events occurred in 2.9% of PVI patients and 4.6% of LEB patients (P < .001), with postdischarge events accounting for 37% of PVI events and 18% of LEB (P ≤ .001). Although the 30-day reoperation rates were 14% for PVI and 18% for LEB (P < .001), almost one-half occurred after discharge (PVI 46% vs LEB 44%; P = .55). Any postoperative major adverse events (MAEs) occurred in 22% of patients after PVI and 31% after LEB, with more than one-half occurring after discharge (PVI 56% vs LEB 53%; P = .17). For claudicants, total 30-day mortality was 0.4% for PVI and 0.7% for LEB (P = .32), with the vast majority of events occurring after discharge (PVI 90% vs LEB 50%; P = .049). The 30-day reoperation rates were 5.2% for PVI and 8.0% for LEB (P < .001), with more than one-half occurring after discharge (PVI 63% vs LEB 53%; P = .09). Any MAEs occurred in 7.0% of patients after PVI and 17% after bypass, with the majority occurring after discharge (PVI 65% vs LEB 63%; P = .66).

CONCLUSIONS

Most MAEs occur less frequently after PVI than LEB. However, a significant number of major of adverse events after lower extremity revascularization occur after leaving the hospital, especially after PVI, which may overestimate its benefits compared with LEB if only in-hospital data are evaluated. These data demonstrate the importance of reporting 30-day rather than in-hospital outcomes when evaluating postoperative adverse events.

Authors+Show Affiliations

Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Surgery, Massachusetts General Hospital, Boston, Mass.Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. Electronic address: mscherm@bidmc.harvard.edu.

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30301689

Citation

Liang, Patric, et al. "In-hospital Versus Postdischarge Major Adverse Events Within 30 Days Following Lower Extremity Revascularization." Journal of Vascular Surgery, vol. 69, no. 2, 2019, pp. 482-489.
Liang P, Li C, O'Donnell TFX, et al. In-hospital versus postdischarge major adverse events within 30 days following lower extremity revascularization. J Vasc Surg. 2019;69(2):482-489.
Liang, P., Li, C., O'Donnell, T. F. X., Lo, R. C., Soden, P. A., Swerdlow, N. J., & Schermerhorn, M. L. (2019). In-hospital versus postdischarge major adverse events within 30 days following lower extremity revascularization. Journal of Vascular Surgery, 69(2), 482-489. https://doi.org/10.1016/j.jvs.2018.06.207
Liang P, et al. In-hospital Versus Postdischarge Major Adverse Events Within 30 Days Following Lower Extremity Revascularization. J Vasc Surg. 2019;69(2):482-489. PubMed PMID: 30301689.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In-hospital versus postdischarge major adverse events within 30 days following lower extremity revascularization. AU - Liang,Patric, AU - Li,Chun, AU - O'Donnell,Thomas F X, AU - Lo,Ruby C, AU - Soden,Peter A, AU - Swerdlow,Nicholas J, AU - Schermerhorn,Marc L, Y1 - 2018/10/06/ PY - 2018/04/10/received PY - 2018/06/16/accepted PY - 2018/10/12/pubmed PY - 2019/4/23/medline PY - 2018/10/11/entrez KW - Angioplasty KW - Chronic limb threatening ischemia KW - Lower extremity bypass KW - Revascularization KW - Stenting SP - 482 EP - 489 JF - Journal of vascular surgery JO - J Vasc Surg VL - 69 IS - 2 N2 - OBJECTIVE: Studies using hospital discharge data likely underestimate postoperative morbidity and mortality after lower extremity revascularization because they fail to capture postdischarge events. However, the degree of underestimation and the timing of postdischarge complications are not well-characterized. METHODS: We used the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted vascular databases from 2011 to 2015 to tabulate 30-day adverse events (in hospital and after discharge) for lower extremity bypass (LEB) and percutaneous vascular interventions (PVIs) performed for claudication and chronic limb-threatening ischemia (CLTI). RESULTS: A total of 14,125 patients underwent lower extremity revascularization, 8909 patients (63%) with LEB and 5216 (37%) with PVI. For CLTI, total 30-day mortality was similar between PVI and LEB (2.3% vs 2.1%; P = .61), but in-hospital deaths only accounted for 43% of PVI mortality and only 65% of LEB mortality (P ≤ .001). Major adverse cardiac events occurred in 2.9% of PVI patients and 4.6% of LEB patients (P < .001), with postdischarge events accounting for 37% of PVI events and 18% of LEB (P ≤ .001). Although the 30-day reoperation rates were 14% for PVI and 18% for LEB (P < .001), almost one-half occurred after discharge (PVI 46% vs LEB 44%; P = .55). Any postoperative major adverse events (MAEs) occurred in 22% of patients after PVI and 31% after LEB, with more than one-half occurring after discharge (PVI 56% vs LEB 53%; P = .17). For claudicants, total 30-day mortality was 0.4% for PVI and 0.7% for LEB (P = .32), with the vast majority of events occurring after discharge (PVI 90% vs LEB 50%; P = .049). The 30-day reoperation rates were 5.2% for PVI and 8.0% for LEB (P < .001), with more than one-half occurring after discharge (PVI 63% vs LEB 53%; P = .09). Any MAEs occurred in 7.0% of patients after PVI and 17% after bypass, with the majority occurring after discharge (PVI 65% vs LEB 63%; P = .66). CONCLUSIONS: Most MAEs occur less frequently after PVI than LEB. However, a significant number of major of adverse events after lower extremity revascularization occur after leaving the hospital, especially after PVI, which may overestimate its benefits compared with LEB if only in-hospital data are evaluated. These data demonstrate the importance of reporting 30-day rather than in-hospital outcomes when evaluating postoperative adverse events. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/30301689/In_hospital_versus_postdischarge_major_adverse_events_within_30_days_following_lower_extremity_revascularization_ DB - PRIME DP - Unbound Medicine ER -