JOURNAL OF VASCULAR SURGERYVolume 60, Number 3 Abstracts 813

2.1% (86) pharmacologic alone, and 13.7% (569) no prophylaxis. The inci-dence of VTE in the high-risk group was 1.3% (54) compared with 0.9%(88) and 0.2% (16) in the medium-risk and low-risk groups, respectively.Of the 54 high-risk patients who developed VTE, 48 (88%) received appro-priate prophylaxis as assigned by the risk-assessment model. The incidenceof VTE in the high-risk group was greater when mechanical and pharmaco-logic prophylaxis were both used (50.0%) compared with pharmacologicalone (3.7%), mechanical alone (35.2%), or no prophylaxis (11.1%; P ¼.05; Fig).

Conclusions: Hospital-acquired VTE develops in high-risk patientsdespite appropriate risk assessment, identification, and prophylaxis withpharmacologic and mechanical methods. Further consideration for moreaggressive prophylaxis should be given to this high-risk patient populationfor VTE prevention.

Fig. Incidence of venous thromboembolism (VTE) in all patients based onprophylaxis.

Table. Comparison of patients treated with endovascularrevascularization (ER) and patients treated with open revascularization(OR)

Variable ER OR P

Age, mean years 73 6 8 64 6 11 .0003Comorbidities, % 62 38 .0026Vessels treated 1.23 6 0.42 1.59 6 0.5 .0032Restenosis, % 25 4 .029Hospital LOS, days 5 6 6 13 6 10 .012Mortality, % 4.8 4 .868

LOS, Length of stay.

Disclosures: A. C. Ring: Nothing to disclose; F. Aziz: Nothing to disclose;M. J. Beck: Nothing to disclose; A. B. Reed: Nothing to disclose

Prospective Cost Analysis and Implications of Wound Complicationsin Lower Extremity Vascular Surgery Proceduresy

Louis L. Nguyen,1 Gregory A. Leya,2 Nathanael D. Hevelone,1 Neal R.Barshes,3 Mark C. Myers,4 Allen D. Hamdan,4 Michael Belkin,1 CharlesK. Ozaki1. 1Brigham and Women’s Hospital, Boston, Mass; 2HarvardMedical School, Boston, Mass; 3Michael DeBakey Veteran’s AffairsMedical Center, Houston, Tex; 4Beth Israel Deaconess Hospital, Boston,Mass

Objectives: Wound complications (WCs), such as surgical site infec-tion, wound dehiscence, hematoma, and seroma after surgery cause signif-icant morbidity and require additional resources to treat. We sought toquantify the marginal cost of WCs in patients undergoing open lower ex-tremity vascular procedures.

Methods: Hospital administrative accounting cost data from a singletertiary institution were analyzed in patients enrolled in a prospective,randomized trial testing two postoperative wound dressings (gauze vs silver-coated alginate). A Wilcoxon rank sum test was used to assess the incremen-tal cost of WCs at 30 days.

Results: Of the 224 patients who underwent lower extremityvascular surgery procedures, 61 (27.2%) developed WC, 40 (17.9%) ofwhich were a surgical site infection. The mean incremental cost ofWCs was $11,973, reflecting a 35% higher cost than non-WC patients(P ¼ .0112). Patients with WCs had a longer mean index length ofstay (8.2 vs 6.0 days, P ¼ .0025), a higher rate of 30-day readmissions(23% vs 6%, P ¼ .0001), and a greater mean cumulative 30-day lengthof stay (10.1 vs 6.2 days, P ¼ .0001). The tested dressings showed noefficacy or cost differences.

Conclusions: WCs remain a frequent sequela of open lower extremityvascular surgery, with significant cost and resource utilization. Although thetested dressing did not demonstrate efficacy in reducing WCs, there remainspotential cost savings for new and effective products or patient care qualityimprovements to capture.

Disclosures: L. L. Nguyen: Grants/research supportdSmith & Nephew;G. A. Leya: Nothing to disclose; N. D. Hevelone: Nothing to disclose;N. R. Barshes: Nothing to disclose; M. C. Myers: Nothing to disclose;

yNew England Society for Vascular Surgery

A. D. Hamdan: Nothing to disclose; M. Belkin: Nothing to disclose;C. K. Ozaki: Grants/research supportdSmith & Nephew

Chronic Mesenteric Ischemia: Outcome Analysis and Predictors ofEndovascular Failurey

Nikolaos Zacharias, Sammy Eghbalieh, R. Clement Darling III, Philip SK.Paty, Paul B. Kreienberg, Sean P. Roddy, Manish Mehta, John B.Taggert, Yarion Sternbach, Kathleen J. Ozsvath, Benjamin B. Chang.Albany Medical College, Albany, NY

Objectives: Outcomes of open (OR) and endovascular revasculariza-tion (ER) for chronic mesenteric ischemia (CMI) were analyzed to identifypredictors of endovascular failure.

Methods: Amulticenter, retrospective studywasperformedof all consec-utive patients with CMI (151 patients/254 vessels) treated from2008 to 2012.Demographics, comorbidities, etiology, and treatment modalities werecompared. Outcomes included technical success, restenosis requiring reinter-vention, complications, mortality, and hospital length of stay (LOS).

Results: A total of 126 patients were treated with ER (83%) and 25 pa-tients with OR (17%). Average follow-up period was 15.5 months. Overallmortality was 4.6% (7 of 151). A comparison between the two groups is re-ported in the Table. Among patients treated with ER, 14.3% developed tech-nical and perfusion-related complications vs 20% in the OR group (P¼ .464).A subgroup analysis showed patients with ER requiring reinterventions had ahigher incidence of long lesions>2 cm on angiography (55% vs 7%, P< .05).Patients crossing over from ER to OR had a significantly higher mortalitycomparedwithERgroup-only (17.6% [3of 17] vs 2.5% [3of 119]),P¼ .007).

Conclusions: ER has similar mortality and shorter hospitalization buthigher rate of restenosis requiring reintervention compared with OR. Pa-tients with ER who require reintervention appear to have longer lesionson angiography. Patients who crossed over from ER had a higher mortalitythan primary OR or ER patients. These findings may guide treatment selec-tion in patients with CMI undergoing ER or OR.

Disclosures: N. Zacharias: Nothing to disclose; S. Eghbalieh: Nothingto disclose; R. Darling: Nothing to disclose; P. S. Paty: Nothing todisclose; P. B. Kreienberg: Nothing to disclose; S. P. Roddy: Nothingto disclose; M. Mehta: Nothing to disclose; J. B. Taggert: Nothing todisclose; Y. Sternbach: Nothing to disclose; K. J. Ozsvath: Nothing todisclose; B. B. Chang: Nothing to disclose

Comparison of Risk Factors for Length of Stay and ReadmissionFollowing Lower Extremity Revascularization>

Scott M. Damrauer,1 Ann C. Gaffey,1 Ann D. Smith,2 Ronald M. Fairman,1

Louis L. Nguyen2. 1Hospital of the University of Pennsylvania,Philadelphia, Pa; 2Brigham and Women’s Hospital, Boston, Mass

Objectives: Recent initiatives have created incentives to reduce lengthof stay (LOS) and decrease readmission rates. We sought to elucidate therisk factors for both outcomes and to clarify the relationship betweenthem in patients undergoing lower extremity bypass (LEB).

Methods: Peripheral arterial disease patients (PAD) who underwentLEB were identified from the 2007 to 2010 California State Inpatient Data-base. Logarithmically transformed LOS and risk factors were analyzed usinglinear regression. Risk factors for 30-day readmission were analyzed usinglogistic regression.

Results: Of 6558 patients who underwent LEB, 1541(24%) werereadmitted. The average index LOS was 8.3 days for those who were

yNew England Society for Vascular Surgery>Eastern Vascular Society

Table. Selected factors independently associated with log-length of stay (LOS) and 30-day readmission

Patient factors

Log-LOS 30-day readmit

Hospitalization factors

log-LOS 30-day readmit

b (SE) P OR (95% CI) P b (SE) P OR (95% CI) P

Age (per decade increase) NS NS 0.92 (0.86-0.99) .02 Admitted fromED (ref: routine)

0.11 (0.03) <.0001 NS NS

History of heart failure e0.1 (0.04) .01 NS NS Multiple procedures 0.35 (0.02) <.0001 1.19 (1.03-1.37) .02Chronic lung disease NS NS 1.19 (1.03-1.37) .02 CHF NS NS 1.27 (1.43-2.10) .008Diabetes without complications NS NS 1.35 (1.16-1.56) <.0001 Pneumonia 0.40 (0.06) <.0001 NS NSDiabetes with complications 0.04 (0.02) .04 1.25 (1.01-1.54) .04 Respiratory failure 0.30 (0.06) <.0001 NS NSHistory of renal failure 0.05 (0.02) .02 1.28 (1.09-1.51) .003 Renal failure 0.20 (0.04) <.0001 NS NSRest pain (ref: claudication) 0.13 (0.02) <.0001 1.33 (1.11-1.61) .002 UTI 0.28 (0.05) <.0001 NS NSFoot ulcers (ref: claudication) 0.21 (0.02) <.0001 1.49 (1.23-1.80) <.0001 Wound/graft

infection0.43 (0.09) <.0001 NS NS

Gangrene (ref: claudication) 0.29 (0.02) <.0001 1.73 (1.43-2.10) <.0001 Hemorrhage 0.10 (0.02) <.0001 NS NS

CHF, Congestive heart failure; CI, confidence interval; ED, emergency department; NS, not significant; SE, standard error; UTI, urinary tract infection.

Table. Proportion of survey respondents who answered each abdominalaortic aneurysm (AAA) knowledge question correctly

Variable Correct, %

Typical size threshold for repair 5-6 cm? 79Larger AAA increases risk of rupture? 68High likelihood of dying if AAA ruptures? 50Heavy lifting does not change risk of rupture? 39Sexual activity does not change risk of rupture? 70Tobacco increases risk of rupture? 69High blood pressure increases risk of rupture? 66AAA runs in families? 36

JOURNAL OF VASCULAR SURGERY814 Abstracts September 2014

readmitted and 5.8 days for those who were not (P < .0001) and was anindependent risk factor for 30-day readmission (odds ratio, 1.01; 95% con-fidence interval, 1.00-1.02 per day). Other significant factors associated withincreased LOS or 30-day readmission on multivariable regression are re-ported in the Table. LOS was primarily driven by the occurrence of postop-erative complications, whereas these were generally not independentlyassociated with 30-day readmission. Rather, 30-day readmissions weredriven by underlying patient disease and comorbidities. Only 453 (29%)of the readmissions were for definitive complications based on primary diag-nosis (International Classification of Diseases, 9 edition, 996-999).

Conclusions: LOS in patients undergoing LEB is driven by theoccurrence of postoperative complications, whereas 30-day readmission isdriven by underlying patient illness. Additionally, increased LOS is an inde-pendent risk factor for readmission. These findings suggest that efforts toreduce LOS and readmission will be complementary. Furthermore, theysupport the notion that LOS and 30-day readmission rates should bothbe risk-adjusted.

Disclosures: S. M. Damrauer: Nothing to disclose; A. C. Gaffey:Nothingto disclose; A. D. Smith: Nothing to disclose; R. M. Fairman: Nothing todisclose; L. L. Nguyen: Nothing to disclose

A National Survey of AAA-Specific Knowledge in Patients With AAAy

Brian Nolan,1 Andrew W. Hoel,2 Mark Wyers,3 Luke Marone,4 RaviVeeraswamy,5 Bjoern Suckow,6 Andres S. Schanzer7. 1Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2Northwestern UniversityFeinberg School of Medicine, Chicago, Ill; 3Beth Israel DeaconessMedical Center, Boston, Mass; 4University of Pittsburgh Medical Center,Pittsburgh, Pa; 5Emory University Hospital, Atlanta, Ga; 6University ofUtah Medical Center, Salt Lake City, Utah; 7UMASS-Memorial HealthCenter, Worcester, Mass

Objectives: Patient education is a fundamental responsibility of vascularsurgeons caring for patients with abdominal aortic aneurysms (AAAs). Wesought to evaluate and quantify AAA-specific knowledge in patients who wereundergoing AAA surveillance and in patients who had undergone AAA repair.

Methods: In 2013, 1373 patients from six United States institutionswere mailed an AAA-specific quality of life and knowledge survey and 1008(73%) returned completed surveys for analysis. The knowledge domain ofthe survey consisted of eight questions. An AAA knowledge score was calcu-lated for each patient based on the proportion of questions answeredcorrectly. The scores were compared according to sex, race, and educationlevel. Surveillance and repaired patients were also compared with additionalcomparison by repair type.

Results: Among 1008 survey respondents, 351 were undergoingAAA surveillance and 657 had undergone AAA repair (endovascular AAArepair [EVAR], 414; open repair, 179; unsure, 64). The majority of patients(85%) reported that their “doctor” was their most important source of AAAinformation. The “internet” and “other written materials” were each re-ported as the most important source of information 5% of the time, with“other patients” reported 2% of the time. The mean (standard deviation)AAA knowledge score was 47% 6 23% (range, 0%-100%), with broad vari-ation in the percentage correct between questions (Table): 32% of respon-dents did not know that larger AAA size increases rupture risk, and 64% did

yNew England Society for Vascular Surgery

not know that AAA runs in families, only 15% of patients answered six ormore of the eight questions correctly, and 23% of patients answered twoor fewer questions correctly. AAA knowledge was significantly greater inmen compared with women, in whites compared with nonwhites, highschool graduates compared with nongraduates, surveillance comparedwith repaired, and EVAR compared with open repair.

Conclusions: In a national survey of AAA-specific knowledge, patientsdemonstrated poor understanding of their condition. This may contribute toanxiety and uninformed decisionmaking. The need for increased focus on ed-ucation by vascular surgeons is a substantial unmet need.

Disclosures: B. Nolan: Grants/research supportdNHLBI, AVA, ACS,PVSS, SVS;A.W.Hoel:Nothing to disclose;M.Wyers:Nothing to disclose;L. Marone: Nothing to disclose; R. Veeraswamy: Nothing to disclose;B. Suckow: Nothing to disclose; A. S. Schanzer: Nothing to disclose

Endovascular Lower Extremity Procedures Are Associated WithImproved Outcomes Compared to Open Surgical Revascularizationin Patients With Chronic Kidney Disease>

Jaime Benarroch-Gampel, A. Omar Nunez Lopez, Charlie C. Cheng,Zulfiqar F. Cheema, Michael B. Silva Jr. The University of Texas MedicalBranch, Galveston, Tex

Objectives: This study compared outcomes in patients with chronickidney disease undergoing lower extremity revascularization procedures.

Methods: Patients with moderate (glomerular filtration rate, 30-59mL/min/1.73 m2) or severe (<30 mL/min/1.73m2) kidney diseasewho underwent lower extremity revascularization procedures (n ¼4313) were identified from the American College of Surgeons NationalSurgical Quality Improvement Program database (2011-2012). Postoper-ative mortality, worsening renal function, respiratory and cardiac events,and combined outcomes were analyzed, with results stratified by degreeof kidney disease. Multivariate analyses were used to adjust for differencesbetween groups.

Results: A total of 2682 patients underwent open procedures(OPs), whereas 1466 had endovascular procedures (EPs). Preoperativemorbidity between the OP vs EP groups was similar for severe kidney dis-ease (11.6% vs 11.3%, P ¼ .80), diabetes (47.8% vs 49.2%, P ¼ .34), and

>Eastern Vascular Society