THE IMPACT OF COMPLICATIONS AFTER VASCULAR-SURGERY IN VETERANS AFFAIRS MEDICAL-CENTERS

The impact of perioperative complications on clinical outcomes and res ource utilization was assessed for 8702 veterans who, during fiscal ye ars 1991-1994, underwent vascular surgery procedures in DRGs 110 and 1 11, which include aortic and peripheral aneurysm repairs as well as re nal artery and some peripheral vascular reconstructions. In-hospital m ortality rate was 6.2% (537/8702). Mortality was 9.8% with any ICD-9-C M-coded complication vs 4.9% without (P < 0.001). Mortality was 28.9% in those with both cardiac and pulmonary complications, 11.0% with eit her cardiac or pulmonary complications, and 3.7% with neither cardiac nor pulmonary complications. Length of stay (LOS) was 25.8 +/- 21.9 da ys 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 int ensity of resource utilization, was greater in those with (3.01 +/- 0. 81) vs without (2.76 +/- 0.70; P < 0.001) a complication. Pulmonary co mplications impacted LOS and RIS more adversely than cardiac. A logist ic regression model of mortality indicated that increasing age [odds r atio (OR) 1.065], arrhythmia (OR 1.31), pneumonia (OR 2.52), surgical complications of the heart (OR 2.8), respiratory insufficiency (OR 4.7 5), stroke (OR 5.48), MI (OR 5.78), and acute renal failure (ARF, OR 9 .58) were associated with increasing likelihood for death, whereas tre atment in the largest, academically affiliated VAMCs (RPM 5) was assoc iated 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 insufficien cy, pneumonia, and stroke progressively increased LOS by linear regres sion analysis, whereas surgical complications of the heart and postope rative death reduced LOS. Complications after vascular surgery have an adverse impact on perioperative mortality, length of stay, and utiliz ation of resources. (C) 1997 Academic Press.