Patient- and procedure-specific risk factors for postoperative complications in peripheral vascular surgery

BACKGROUND: Interest in measuring the quality of surgical care has grown over the past decades. As complications after vascular surgery may be used as a quality indicator of care, analysis of these adverse events remains essential. OBJECTIVE: The goal of this study was to identify patient and procedure specific risk factors of postoperative complications following infrainguinal vascular surgery and to describe the incidence, cause and consequence of all complications in this group. PATIENTS AND METHODS: This study included all 296 patients undergoing infrainguinal arterial bypass surgery at our institution over a 5-year period. All complications occurring during these patients' admission were registered in a prospective standardised complication registration and analysed. RESULTS: Seventy-three of 296 (25%) procedures in 247 patients were followed by 129 complications. The mean patient age was 70 years. Factors associated with a significantly higher complication risk were diabetes, critical ischaemia with rest pain or gangrene, a cardiac medical history, acute surgery and a former cerebrovascular accident (CVA). Independent risk factors in multivariate analysis were a former CVA and acute surgery. Postoperative haemorrhage (n = 19), early occlusion of the graft (n = 15) and surgical site infection (n = 10) were the most frequently registered surgery-related complications. The most common consequence of a complication was blood transfusion or treatment with additional medication (33%). In 16% of all complications, a reoperation was necessary. Twelve patients died during admission (mortality 5%). CONCLUSION: A former CVA and acute surgery were independent risk factors of postoperative complications. Identifying the cause and consequence of each complication is essential in a complication registration. When using complications as an indicator of quality of care in this population, an adjustment should be made for patient comorbidity and surgical indication.