Journal of vascular surgery
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Hospital length of stay (LOS) contributes to costs. Carotid endarterectomy (CEA) is performed frequently by vascular surgeons, making contemporary CEA LOS rates and predictors vital knowledge for quality evaluation and cost containment initiatives. ⋯ Nearly half of CEA patients were discharged on or after postoperative day 2. Interventions on modifiable risk factors, such as early Foley catheter placement to prevent urinary retention and morning CEA scheduling, may decrease LOS. ELOS may identify a subset of patients at increased risk for long-term readmission and mortality.
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Readmission is associated with high mortality, morbidity, and cost. We used the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) to determine risk factors for readmission after lower extremity bypass (LEB). ⋯ Readmissions are common after LEB. Optimization of select chronic conditions, closer follow-up of patients in poor health and those who required return to the operating room, and early detection of surgical site infections may improve readmission rates. Our finding that 25% of readmissions after LEB are not procedure related informs the broader discussion of how a readmission penalty affects vascular surgery in particular.
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To analyze biomechanical, histologic, and histochemical properties of anterior fragments of abdominal aortic aneurysms (AAA) and to correlate them with the maximum transverse diameter (MTD) and symptoms associated to the aneurysms. ⋯ The fragments of the anterior midsection from larger aneurysms were more resistant than those from smaller abdominal aortic aneurysms, with no tissue properties that could explain this phenomenon in the histologic or histochemical analyses. Larger aneurysms, at least in this place may be stronger than smaller aneurysms. It could point toward regional differences (heterogeneity, localized pathologies) as an important player in aneurysm rupture. Uniaxial strain tests are an important tool for the comprehension of a complex behavior such as that from an aneurysmal aortic wall. However, these tests still have limitations in providing information that would allow the calculation of the risk of rupture for abdominal aortic aneurysms.
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Vascular surgery patients have high readmission rates, and identification of high-risk groups that may be amenable to targeted interventions is an important strategy for readmission prevention. This study aimed to determine predictors of unplanned readmission and develop a risk score for predicting readmissions after vascular surgery. ⋯ Through the use of patient, operative, and predischarge events, this novel vascular surgery-specific readmission score accurately identified patients at high risk for 30-day unplanned readmission. This model could help direct discharge and home health care resources to patients at high risk, ultimately reducing readmissions and improving efficiency.
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Experimental modeling of arteriovenous hemodialysis fistula (AVF) hemodynamics is challenging. Mathematical modeling struggles to accurately represent the capillary bed and venous circulation. In vivo animal models are expensive and labor intensive. We hypothesized that an in vitro, physiologic model of the extremity arteriovenous circulation with provisions for AVF and distal revascularization and interval ligation (DRIL) configurations could be created as a platform for hemodynamic modeling and testing. ⋯ The complications of arteriovenous fistula (AVF)-associated steal with its concurrent surgical treatments have been clinically described but have relatively little published, concrete hemodynamic data. A further understanding of the underlying hemodynamics is necessary to prevent the occurrence of steal and improve treatment when it occurs. Specific objectives are to study the blood flow through an AVF with varying anatomic and physiologic parameters, determine what factors contribute to the development of arterial steal distal to an AVF, and create optimal interventions to treat arterial steal from an AVF when it occurs. The long-term goal is creation of AVF tailored to patient-specific parameters, resulting in higher rates of functional fistulas with decreases in fistula-related complications. The ability to study fluid dynamics using a unique, in vitro, upper extremity pulsatile arteriovenous circulation simulator creates the ideal platform for this work.