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| 2007 JASN IMPACT FACTOR 7.111 | HOME AUTHOR INFO EDITORIAL BOARD SUBSCRIBE FEEDBACK ALERTS HELP | |||
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*Department of Medicine, San Francisco VA Medical Center, San Francisco, California; Department of Medicine, University of California, San Francisco, California; Division of General Internal Medicine, Northwestern University Medical School, Chicago, Illinois; Surgical Services, Washington DC VA Medical Center, Washington, DC; ¶Department of Surgery, George Washington University, Washington, DC; #Department of Surgery, Georgetown University, Washington, DC; @Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; **Department of Medicine, San Francisco General Hospital, San Francisco, California; Clinical Effectiveness, Medical Affairs, Tenet Health System, Dallas, Texas; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; ¶¶Surgical Services, VA Boston Healthcare System, Boston, Massachusetts; ##University of Colorado Health Outcomes Program, Denver, Colorado.
Correspondence to Dr. Ann M. O’Hare, Renal Fellow, Department of Medicine, San Francisco VAMC and Department of Medicine, University of California, San Francisco (UCSF), Address: Box 111J, Nephrology Division, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121. Phone: 415-221-4810 ext. 4953; Fax: 415-476-3381;
ABSTRACT. Few data are available on the impact of renal insufficiency on short-term operative outcomes after lower extremity surgical revascularization. We used prospectively collected data from the Department of Veterans Affairs’ National Surgical Quality Improvement Program (NSQIP) to explore the association with renal dysfunction of adverse outcomes occurring within 30 d of lower extremity surgical revascularization in a cohort of all patients undergoing at least one lower extremity surgical revascularization from 1/1/94 to 9/30/01 (n = 18,217). Even moderate renal insufficiency (estimated GFR 30-59cc/min/1.73m2) was associated with an increased incidence of postoperative death (adjusted odds ratio (OR) 1.44, 95% confidence interval (CI), 1.17 to 1.77, P = 0.001), cardiac arrest (OR 1.43, CI 1.09 to 1.88, P = 0.011), myocardial infarction (OR 1.68, 1.39 to 2.16, P < 0.001), unplanned intubation (OR 1.69, CI 1.39 to 2.07, P < 0.001) and prolonged intubation (OR 1.57, CI 1.28 to 1.94, P < 0.001) within 30 d of lower extremity revascularization. However, the incidence of wound infection and graft failure requiring return to the operating room did not appear to be substantially higher in this group. Our data also show that patients with renal insufficiency undergoing revascularization were more likely to require distal procedures and to present with limb-threatening infection compared to those with normal renal function. Efforts to improve pre-and post-operative care in patients with renal insufficiency undergoing lower extremity revascularization should take into account the increased incidence of postoperative death and cardiopulmonary complications in this group in addition to more traditional concerns about operative site complications. Further studies are needed to explore reasons for the higher rate of limb-threatening infection in patients with renal insufficiency undergoing revascularization. E-mail: annohare@yahoo.com
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