Failure to rescue and mortality after reoperation for abdominal aortic aneurysm repair

Abstract

Complications after abdominal aortic aneurysm (AAA) repair resulting in reintervention increase mortality risk, but have not been well studied. Mortality after reintervention is termed failure to rescue and may reflect differences related to quality management of the complication. This study describes the relationship between reoperation and mortality and examines the effect of physician speciality on reintervention rates and failure to rescue after AAA repair. Data were extracted for 2616 patients who underwent intact AAA repair in 2005 to 2006 from a standard 5% random sample of all Medicare beneficiaries. Patient demographics, comorbidities, hospital characteristics, repair type, and speciality of operating surgeon were collected. Primary outcomes were 30-day reoperation and 30-day mortality. Logistic regression analysis identified characteristics predicting reoperation. A total of 156 reoperations were required in 142 (4.2%) patients. Early mortality was far more likely for patients requiring reintervention than for those who did not (22.5% vs 1.5%; P < .0001). Of patients requiring reoperation, those requiring two or more interventions had an even higher mortality (54% vs 20%; P = .0007). Despite equivalent reoperation rates between specialities (vascular surgeons, 5.2%; others, 5.6%, P = .67), the mortality after reoperation was nearly half for vascular surgeons compared with other specialities (16.2% vs 32.3%; P = .04). The most common reason for reoperation was arterial complications (35.8%) accounting for the largest difference in mortality between vascular surgeons (30.7%) and other specialities (52.0%). Postoperative complications requiring reoperation dramatically increase mortality after AAA repair. Despite similar complication rates, vascular surgeons showed lower mortality rates after reoperation.