Journal of vascular surgery
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Multicenter Study
Reliability of hospital readmission rates in vascular surgery.
The Center for Medicare and Medicaid Services recently began assessing financial penalties to hospitals with high readmission rates for a narrow set of medical conditions. Because these penalties will be extended to surgical conditions in the near future, we sought to determine whether readmissions are a reliable predictor of hospital performance with vascular surgery. ⋯ Risk-adjusted readmission rates for vascular surgery vary substantially year to year; this implies that much of the observed variation in readmission rates is either random or caused by unmeasured factors and not caused by changes in hospital quality that may be captured by administrative data.
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Multicenter Study Comparative Study
Contemporary comparison of supra-aortic trunk surgical reconstructions for occlusive disease.
Open surgical reconstruction for supra-aortic trunk occlusive disease persists despite advances in endovascular therapy. Although extrathoracic reconstructions developed as a safer alternative to transthoracic reconstructions, contemporary national data evaluating relative rates of operative outcomes are lacking. ⋯ At U.S. hospitals, extrathoracic reconstruction is the more common reconstruction for supra-aortic trunk occlusive disease. Both approaches carry acceptably low rates of death, MI, and stroke. Transthoracic reconstruction results in more resource utilization because of its postoperative complications and greater complexity.
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Multicenter Study
Effect of antifibrinolytic therapy with tranexamic acid on abdominal aortic aneurysm shrinkage after endovascular repair.
The long-term outcomes of endovascular abdominal aortic aneurysm repair (EVAR) remain to be determined, but patients with aneurysm shrinkage after EVAR appear to have a good prognosis. We previously observed that antiplatelet therapy is a risk factor for lack of aneurysm shrinkage, a finding suggesting that coagulation and fibrinolysis play roles in shrinkage. We therefore studied the effect of antifibrinolytic therapy with tranexamic acid (TXA) on aneurysm shrinkage after EVAR. ⋯ Antifibrinolytic therapy with TXA was associated with aneurysm shrinkage after EVAR. Studies to identify the dosage of TXA that is optimally safe and effective in this application, as well as investigations of the best timing and route (parenteral vs oral) for TXA administration, are warranted.
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Perioperative outcomes after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) have been rigorously studied; however, inpatient and postdischarge outcomes have not been separately analyzed. The objective of this study was to examine postdischarge 30-day outcomes after elective EVAR. ⋯ Patient characteristics associated with a higher risk for postdischarge adverse events after EVAR were identified. Whether improved predischarge surveillance and close postdischarge follow-up of identified high-risk patients will further improve 30-day outcomes after EVAR needs to be prospectively studied.
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Multicenter Study Comparative Study
Failure to rescue and mortality following repair of abdominal aortic aneurysm.
Recently, failure to rescue (FTR; death following major complication) has been shown to be a primary driver of mortality in highly morbid operations. Establishing this relationship for open and endovascular repair of abdominal aortic aneurysms may be a critical first step in improving mortality following these procedures. We sought to examine the relative contribution of severe complications and FTR to variations in mortality rate. ⋯ FTR appears to drive a large proportion of the variation in mortality associated with abdominal aortic aneurysm repair. The exact mechanisms underlying this variation remain unknown. Nonetheless, FTR is influenced by the structural characteristics and safety culture related to the timely recognition and management of severe complications. Hospitals that are unable to effectively handle severe complications following EVAR or OAR require close scrutiny.