Factors associated with early failure of infrainguinal lower extremity arterial bypass

Abstract

We analyzed the Veterans Affairs (VA) National Surgical Quality Improvement Program (NSQIP), a large clinical database, to investigate which factors, other than technical, were associated with a higher incidence of early graft failure in infrainguinal bypass. Data are prospectively collected in NSQIP from 123 participating VA Medical Centers. All patients from 1995 to 2003 in the NSQIP database who underwent infrainguinal arterial bypass were identified by Current Procedural Terminology (CPT) codes (CPT is a registered trademark of the American Medical Association, Chicago, Ill, Copyright 2007). Data for 30-day graft failure were evaluated by univariate analysis, and multivariate logistic regression was used to control for possible confounders. The NSQIP database identified 14,788 patients who underwent infrainguinal lower extremity arterial bypasses during the study period, and 723 acute graft failures (4.9%) occurred. On multivariate analysis, compared with patients aged >70 years, patient ages of <50 and 51 to 60 years were significantly associated with early graft failure (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.6-3.0; P < .001; OR, 1.4; 95% CI, 1.2-1.6, P < .001; respectively); age range of 61 to 70 years was not significantly associated with early graft failure. African American race was also associated with early graft failure, and diabetes mellitus had a negative association with early graft failure (OR, 1.4; 95% CI, 1.3-1.5; P < .001; OR, 0.72; 95% CI, 0.58-0.89; P = .002; respectively). Although smoking was a significant factor for acute graft failure on univariate analysis, it was not significant on multivariate analysis. Multivariate analysis of the type of procedure performed revealed that femoral to popliteal bypass with vein or prosthetic graft was associated with better early graft patency than any of the tibial vessel bypass procedures except for popliteal to tibial bypass with autogenous vein. These data suggest that factors other than technique have an effect on the 30-day graft failure rates of infrainguinal bypasses. These results help the vascular surgeon to predict more accurately early bypass failure rates while planning the procedure and counseling patients about its prognosis.