The impact of complications after vascular surgery in Veterans Affairs Medical Centers

Abstract

The impact of perioperative complications on clinical outcomes and resource utilization was assessed for 8702 veterans who, during fiscal years 1991-1994, underwent vascular surgery procedures in DRGs 110 and 111, which include aortic and peripheral aneurysm repairs as well as renal artery and some peripheral vascular reconstructions. In-hospital mortality rate was 6.2% (537/8702). Mortality was 9.8% with any ICD-9-CM-coded complication vs 4.9% without (P < 0.001). Mortality was 28.9% in those with both cardiac and pulmonary complications, 11.0% with either cardiac or pulmonary complications, and 3.7% with neither cardiac nor pulmonary complications. Length of stay (LOS) was 25.8 +/- 21.9 days with any ICD-9-CM-coded complication vs 18.9 +/- 14.1 days without (P < 0.001). Further, RIS (Resource Intensity Scale), a measure of intensity of resource utilization, was greater in those with (3.01 +/- 0.81) vs without (2.76 +/- 0.70; P < 0.001) a complication. Pulmonary complications impacted LOS and RIS more adversely than cardiac. A logistic regression model of mortality indicated that increasing age [odds ratio (OR) 1.065], arrhythmia (OR 1.31), pneumonia (OR 2.52), surgical complications of the heart (OR 2.8), respiratory insufficiency (OR 4.75), stroke (OR 5.48), MI (OR 5.78), and acute renal failure (ARF, OR 9.58) were associated with increasing likelihood for death, whereas treatment in the largest, academically affiliated VAMCs (RPM 5) was associated with reduced mortality (OR 0.795). Increasing age, treatment in the largest affiliated (RPM 5) hospitals, arrhythmia, MI, CHF, any ICD-9-CM-coded complication, acute renal failure, respiratory insufficiency, pneumonia, and stroke progressively increased LOS by linear regression analysis, whereas surgical complications of the heart and postoperative death reduced LOS. Complications after vascular surgery have an adverse impact on perioperative mortality, length of stay, and utilization of resources.