Perioperative Infections after Open Abdominal Aortic Aneurysm Repair Lead to Increased Risk of Subsequent Complications

Background Patients undergoing open abdominal aortic aneurysm (AAA) repair are at risk of perioperative infections that can lead to subsequent complications. Our goal was to understand how an initial infectious complication influences the risk of subsequent complications in this cohort of patients. Methods Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005–2012), we evaluated the relationship between 3 index infectious complications after open elective AAA repair (pneumonia, deep/organ surgical site infection [SSI], and urinary tract infection [UTI]) and subsequent complications. We used 5:1 propensity matching and calculated propensity score to experience to establish matching cohorts for each index complication. This score was based on preoperative variables and number of event-free days. Results There were 3,991 patients who were identified to have undergone elective open AAA repair in the ACS-NSQIP database. Postoperative index pneumonia was associated with increased risk of unplanned intubation (28.6% vs. 3.5%; odds ratio [OR], 10.9; 95% confidence interval [CI]: 6.7–17.5; P P P P P  = 0.035), and mortality (7.1% vs. 3.0%; OR, 2.5; 95% CI: 1.3–4.9; P  = 0.009). Postoperative index UTI was associated with increased risk of sepsis (21.4% vs. 0%; OR, 49.2; 95% CI: 14.5–166.8; P P  = 0.001), DVT (3.6% vs. 0.4%; OR, 10.0; 95% CI: 1.8–55.5; P  = 0.008), and mortality (5.4% vs. 1.8%; OR, 3.0; 95% CI: 1.1–8.5; P  = 0.02). Finally, postoperative index deep/organ SSI increased the risk of pneumonia (13.0% vs. 0.9%; OR, 16.7; 95% CI: 1.6–168.2; P  = 0.017), prolonged ventilation (21.7% vs. 0.9%; OR, 30.8; 95% CI: 3.4–279.4; P  = 0.002), and sepsis (13.0% vs. 0.9%; OR, 16.7; 95% CI: 1.6–168.2; P  = 0.017). Conclusions A postoperative nosocomial infection after open AAA repair is significantly more likely to lead to serious subsequent complications. Prevention and early identification of infectious index complications and subsequent complications could allow for interventions that could decrease morbidity and mortality.