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Duration of Femoral-Popliteal Bypass Influences Patient Outcomes
Tze-Woei Tan, MD, Jeffrey Kalish, MD, Naomi Hamburg, MD, Robert Eberhardt, MD, Gheorghe Doros, MD, Denis Rybin, MD, Alik Farber, MD
Boston Medical Center, Boston University School of Medicine and Public Health, Boston, MA
Background: Duration of femoral-popliteal bypass(FPB) is based on multiple factors and is subject to significant variability. We hypothesized that shorter operative duration is associated with improved outcomes and may represent a potential quality improvement measure.
Methods: Patients who underwent primary FPB with autogenous vein between 2005 and 2009 were identified from American College of Surgeons National Surgical Quality Improvement Program(NSQIP) dataset using International Classification of Diseases Code, Ninth edition(ICD- 9). We evaluated the association between operative time in quartiles and perioperative outcomes(mortality, surgical site infection (SSI), cardiopulmonary complications, and length of hospital stay(LOS)) adjusting for relevant confounders(age, body mass index, diabetes, dialysis and indication) using multivariable regression.
Results: There were 2,735 FPB in our study. The mean age was 65.9 +/- 11.5 years and 62.3% of patients were male. Operative duration quartiles(Q) were determined in minutes(Q1:?149, Q2:150-192, Q3:193-248, Q4:?249. In multivariable analysis, after adjusting for patient factors, longer operative duration was associated with higher SSI and longer hospital LOS(Table). In particular, operative duration of ? 260 minutes increased the risk of SSI by 50% compared to risk at surgery time Q1(150 minutes). There were no differences in mortality or cardiopulmonary morbidity across time quartiles.
Conclusion: Longer duration of FPB, when controlled for patient-specific factors, is associated with a significantly higher risk of perioperative SSI and longer hospital LOS. Surgical techniques that lead to faster operative time may lead to improved clinical outcomes and resource utilization.
Table: Adjusted association of Surgery Duration, SSI and Hospital Length of Stay
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