IP059. Functional Status Rather Than Age Is a Better Predictor of Postoperative Outcomes After Excision of an Infected Abdominal Graft

Excision of an infected abdominal graft is a serious undertaking. Whereas most surgeons agree on the operative approach for young/good functional status patients and nonoperative approach for old/poor functional status patients, the management of young/poor functional status and old/good functional status patients is less clear. We need more data on how these patients do after graft explantation to offer sound medical advice preoperatively. We used the CPT code 35907 to identify all patients undergoing excision of infected abdominal graft in the 2005 to 2017 American College of Surgeons National Surgical Quality Improvement Program database. Patients were first stratified by age using the top age quartile as a cutoff at 75 years old, and then by functional status (independent vs dependent). Dependent is defined in National Surgical Quality Improvement Program as “requiring assistance in all activities of daily living.” We studied four groups: group 1—young (<75) and independent, group 2—young (<75) and dependent, group 3—old (≥75) and independent, and group 4—old (≥75) and dependent. Outcomes measured include 30-day mortality and major adverse events. Using group 1 as a control, we performed multivariable logistic regression to analyze the outcomes of groups 2 and 3. There were 814 patients who underwent excision of an infected abdominal graft: 508 patients (62%) belonged to group 1, 89 patients (11%) were in group 2, 176 patients (22%) were in group 3, and 41 patients (5%) were in group 4. As expected, group 1 had the lowest mortality rate (13.4%) whereas group 4 had the highest mortality rate (41.5%). The mortality rates for groups 2 and 3 were similar at 23% to 24%. Pulmonary complications were highest in dependent patients regardless of age (46%-47% in groups 2 and 4). The effect of age on outcomes was tested by comparing group3 versus group 1 and multivariable analysis showed no significant difference in mortality or major organ dysfunction between these two groups. On the contrary, when the effect of functional status was tested by comparing group 2 versus group 1, group 2 had significantly higher rates of pulmonary complications (odds ratio, 2.22; 95% confidence interval, 1.33-3.73; P = .002) and return to the operating room (odds ratio, 2.67; 95% confidence interval, 1.62-4.41; P < .001; Table). Functional status is much more important than age in determining postoperative outcomes after excision of infected abdominal grafts. Therefore, this procedure should be considered in elderly patients who have good functional status. In contrast, caution should be applied in dependent patients regardless of age owing to a high risk of pulmonary complications.TableThirty-day outcomes of infected abdominal graft excision according to age and functional statusOutcomesOutcomes by age and functional statusMultivariable analysisGroup 1Group 2Group 3Group 4Group 2 versus group 1Group 3 versus group 1<75 Years and independent (n = 508) No., %<75 Years and dependent (n = 89) No., %≥75 Years and independent (n = 176) No., %≥75 Years and dependent (n = 41) No., %Odd ratio (95% CI)P valueOdd Ratio (95% CI)P valueMortality68 (13.4)22 (24.7)41 (23.3)17 (41.5)1.66 (0.90-3.09).5361.31 (0.78-2.19).311Cardiac37 (7.3)11 (12.4)14 (8.0)4 (9.8)1.33 (0.59-2.97).4900.76 (0.36-1.57).454Stroke4 (0.8)2 (2.3)1 (0.6)0 (0)0.80 (0.07-8.53).8512.82 (0.17-47.41).472Pulmonary139 (27.4)42 (47.2)59 (33.5)19 (46.3)2.22 (1.33-3.73).0021.04 (0.68-1.58).874Renal72 (14.2)20 (22.5)16 (9.1)4 (9.8)1.80 (0.98-3.31).0580.57 (0.31-1.08).086Sepsis127 (25.0)32 (36.0)51 (29.0)10 (24.4)1.43 (0.85-2.41).1800.93 (0.60-1.45).749Wounds58 (11.4)14 (15.7)33 (18.8)5 (12.2)1.38 (0.64-2.96).4120.90 (0.53-1.53).692VTE17 (3.4)2 (2.3)5 (2.8)0 (0)0.65 (0.13-3.20).6000.43 (0.14-1.33).143Return to OR126 (24.8)42 (47.2)31 (17.6)14 (34.2)2.67 (1.62-4.41)