Impact of Hospital-Acquired Infection on Long-Term Outcomes after Endovascular and Open Abdominal Aortic Aneurysm Repair

Abstract

We hypothesized that infectious complications after open surgery (OPEN) and endovascular repair (EVAR) of nonruptured abdominal aortic aneurysms (AAAs) negatively affected long-term outcomes. Elective OPEN and EVAR cases were selected from 2005-2007 Medicare databases, and rates of postoperative infection, readmission, and longitudinal mortality were compared. Forty thousand eight hundred ninety-two EVARs and 16,669 OPEN AAA repairs were evaluated. Patients with OPEN developed infection during and after the index hospitalization (12.8% and 4.9%, respectively) more often than those who had undergone EVAR (3.2% and 3.9%, respectively; P < 0.0001 for both). Patients with hospital-acquired infection compared to noninfectious ones were more likely to die during the index hospitalization (odds ratio [OR]: 3.7 [95% confidence interval {CI}: 3.22-4.30]) and within 30 days after discharge (OR: 3.6 [95% CI: 2.83-4.45]). They also were more likely to be readmitted to the hospital during 30 days after index discharge (OR: 1.8 [95% CI: 1.63-1.94]). Index infections associated with the greatest readmission were urinary tract infection after OPEN and sepsis after EVAR. Hospital-acquired infection significantly increased the duration of hospital stay (14.2 ± 13.2 vs 4.0 ± 4.4 days; P < 0.0001) and total hospital charges ($133,070 ± $136,100 vs $66,359 ± $45,186; P < 0.0001). The most common infections to develop 30 days after initial discharge were surgical site infection after EVAR (1.27%) and urinary tract infection after OPEN (1.38%). Hospital-acquired infections had a dramatic effect by increasing hospital and 30-day mortality, readmission rates, and hospital resource use after AAA repair. Programs minimizing infectious complications may decrease future readmissions and mortality after AAA repair.