Aortic Surgery for Aortic Graft Infections: Defining National Benchmarks for Standards of Care

Abstract

Published literature on postoperative outcomes after aortic surgery for prosthetic aortic graft infection (AGI) is limited by relatively small sample sizes resulting in lack of national benchmarks for quality of care. We report in-hospital outcomes after aortic surgery for AGI and identify factors associated with postoperative complications using the Nationwide Inpatient Sample (NIS) database. Patients who underwent aortic graft resection for AGI were identified from the 2002 to 2008 NIS database, a multicenter database capturing 20% of all United States admissions. Multivariable logistic regression analyses were performed. In 394 patients (73.4% men) who underwent aortic surgery for AGI, median age was 72 years. Fifty-three percent of the admissions were emergent or urgent. Median hospital volume of aortic surgery for AGI during the study period was one case. A significant trend for decreasing number of AGIs per year was observed during the study span (Pearson's correlation r = −0.96; P = .0006). During the same time span, a significant correlation was also seen with decrease in open, and increase in endovascular aortic aneurysm repairs in the NIS database (Fig). In-hospital rates of overall postoperative morbidity and mortality were 68.3% and 19.8%, respectively. In-hospital rates of postoperative respiratory failure, renal failure, and cardiac arrest were 35.5%, 14.2%, and 8.9%, respectively. Median length of stay was 26 days, with median hospital charges being $184,162. On multivariable analysis, increase in age per year (odds ratio, 1.07; 95% confidence interval, 1.03-1.12) was independently associated with postoperative morbidity, whereas higher hospital volume for this procedure was protective (odds ratio, 0.71; 95% confidence interval, 0.56-0.89). On multivariable analysis, no preoperative factors were independently associated with postoperative mortality. AGI incidence has progressively declined during the span of our study in association with decreased open and increased endovascular aortic aneurysm repairs. Aortic surgery for AGI is associated with very high morbidity and mortality rates, along with prolonged lengths of stay and elevated hospital charges. The outcomes of operations for AGI are better in younger patients and higher volume hospitals.