Search Results (773)

Influenza A (H5N1) is a highly pathogenic zoonotic virus with a human fatality rate of approximately 60%. Pediatric cases and associated neurological manifestations remain poorly documented in Latin America. This report describes the first confirmed Ecuadorian pediatric case of H5N1-associated encephalitis and multisystem organ failure in a previously healthy 9-year-old female following direct contact with infected poultry. The clinical course was characterized by an atypical initial presentation of bilateral periorbital edema and headache, progressing to acute encephalitis, cerebral ischemia, flaccid tetraplegia, central diabetes insipidus, and refractory septic shock. Diagnostic confirmation was achieved via nasopharyngeal RT-PCR, with additional RT-PCR and sequencing performed on cerebrospinal fluid, which identified conserved influenza A M1/M2 gene fragments, while laboratory markers—including marked elevations in IL-6, ferritin, and CRP—indicated a severe hyperinflammatory state. Management involved an intensive multidisciplinary approach utilizing oseltamivir, intravenous immunoglobulin, modulated-dose corticosteroids, desmopressin, and mechanical ventilation. Despite a severe clinical course, the patient achieved a favorable recovery, with a Glasgow Coma Scale score of 15/15 at discharge and only partial residual paresis and left hypoacusia as sequelae. This landmark case provides rare evidence of H5N1 neuroinvasion in a pediatric patient and demonstrates that timely detection combined with aggressive immunotherapy and antiviral treatment can improve survival. Furthermore, it underscores the critical necessity for strengthened regional molecular surveillance and clinical training to recognize atypical presentations of emerging zoonoses in Latin America, especially in cases involving contact with sick poultry. Full article

Background and Objectives: Rheumatic diseases confer excess cardiovascular risk, yet prognosis after acute coronary syndrome (ACS) in contemporary angiography-treated care remains incompletely characterized, particularly when psychiatric multimorbidity is considered. We evaluated whether documented rheumatic disease was associated with psychiatric comorbidity and post-discharge mortality after ACS. Materials and Methods: We retrospectively analyzed a predefined two-center registry extract of 2950 consecutive patients who underwent coronary angiography for ACS. Documented rheumatic disease was identified from diagnoses recorded in admission history, prior medical records, or discharge documentation and was not re-adjudicated. The primary outcome was post-discharge all-cause mortality. Results: Documented rheumatic disease was present in 106 patients (3.6%). Compared with patients without documented rheumatic disease, exposed patients were older, more often women, more often hypertensive, and more likely to have a documented psychiatric disorder (25.5% vs. 14.1%). Short-term mortality was similar, whereas crude overall long-term mortality was higher (27.4% vs. 19.3%). Among hospital survivors with usable follow-up, post-discharge survival was worse (log-rank p = 0.013). Documented rheumatic disease was associated with higher post-discharge mortality in unadjusted analysis (hazard ratio 1.66, 95% confidence interval 1.11–2.48) and in a prespecified parsimonious model (adjusted hazard ratio 1.56, 95% confidence interval 1.04–2.34); the association attenuated and was no longer statistically significant in a broader exploratory model (adjusted hazard ratio 1.35, 95% confidence interval 0.87–2.07). Documented psychiatric disorder independently predicted mortality. Conclusions: In angiography-treated ACS, documented rheumatic disease was associated with greater psychiatric comorbidity and worse post-discharge survival in a small, documentation-defined, heterogeneous subgroup. Because the signal attenuated in broader exploratory adjustment and exposure ascertainment was documentation-based, the findings should be regarded as hypothesis-generating rather than disease-specific or causal. Full article

Background/Objectives: Neuroprognostication after out-of-hospital cardiac arrest (OHCA) remains clinically challenging, particularly when withdrawal of life-sustaining treatment (WLST) is considered. International guidelines recommend delayed, multimodal assessment, but real-world descriptions of how this is operationalised within multidisciplinary pathways remain limited. Methods: We conducted a single-centre retrospective observational cohort study of adults admitted to a tertiary cardiac arrest centre intensive care unit following OHCA between June 2022 and December 2025. Patients were conveyed according to the British Cardiovascular Intervention Society OHCA pathway; therefore, this was a selected cardiac arrest centre cohort enriched for shockable rhythms and suspected reversible cardiac causes, rather than an unselected OHCA population. Patients who remained unconscious at ≥72 h following a sedation hold entered a structured multidisciplinary team (MDT) neuroprognostication pathway. Outcomes included survival to hospital discharge, Cerebral Performance Category (CPC) at discharge, neuroprognostication investigation use, and timing of WLST. Results: Of 406 patients admitted following OHCA, 310 were admitted to ICU and included in the analysis. The cohort was predominantly male (82.3%), with a mean age of 63.8 years; 82.9% had ventricular fibrillation as the initial rhythm. Overall, 182 patients (58.7%) survived to hospital discharge, of whom 160 (87.9%) had a favourable neurological outcome (CPC 1–2). A total of 119 patients entered the neuroprognostication pathway. Of these, 72 underwent WLST after completed MDT review, 10 died before MDT decision-making, and 37 survived to hospital discharge. Among patients undergoing WLST, investigation use was high: CT brain 100%, NSE 91.7%, EEG 90.3%, SSEP 88.9%, and MRI brain 27.8%. Median time to WLST was 5.5 days. Conclusions: In this selected tertiary CAC cohort, enriched for shockable rhythms through BCIS pathway-based conveyance, survival to hospital discharge was high and neurological outcomes among survivors were predominantly favourable. Within this setting, delayed, multimodal neuroprognostication and WLST decision-making were operationalised through a structured MDT pathway aligned with contemporary guideline recommendations. These findings provide contemporary real-world benchmark data on pathway implementation for comparable centres seeking to evaluate or develop structured neuroprognostication services. Full article

Background: Several studies reveal an inverse relation between serum 25-hydroxyvitamin D [25(OH)D] concentration and the risk of acute ischemic stroke (AIS). The aim of this study was to determine relationships between 25(OH)D concentration and the course and outcomes of AIS treatment and the level of indices of inflammatory response to brain injury. Patients and Methods: Retrospective analysis of medical documentation of 1381 real-world AIS patients hospitalized in a single center between 1 January 2020 and 31 May 2025. Serum 25(OH)D level, several inflammatory indices, and clinical data were assessed. Results: Compared to patients in the lowest quartile of 25(OH)D concentration, those in the highest quartile had a shorter length of in-hospital stay, a lower risk of all-cause death, and a lower score for disability on a modified Rankin scale (mRS). Along with an increase in 25(OH)D quartiles, we found: a decrease in neutrophil count; a decrease in glucose, HbA1c, albumin, C-reactive protein (CRP), and CRP-to-albumin, -lymphocyte, -neutrophil, and -platelet ratios; lower neutrophil-to-lymphocyte and -albumin ratios, and lower systemic immune inflammation, and systemic inflammation response indices. In multifactorial logistic regression, the quartile of 25(OH)D (OR, 95% CI: 1.52, 1.09–2.12; p = 0.012) was the only variable to have a positive association with a mRS score ≤ 2 at discharge from hospital, and neutrophil-to-lymphocyte ratio, age, diabetes, and treatment with endovascular mechanical thrombectomy were biomarkers of poor functional status at discharge. Conclusions: Higher 25(OH)D concentration in AIS patients is related to better survival and a lower level of inflammatory response indices and disability at discharge. Full article

Background: Cancer cachexia and sarcopenia are highly prevalent complications affecting up to 50% of patients with cancer and are associated with increased treatment toxicity, poorer functional outcomes, and reduced survival. Early identification of muscle deterioration during hospitalization remains challenging. Objective: To evaluate the change in dominant-hand handgrip strength between hospital admission and discharge in hospitalized oncology patients. Methods: This prospective longitudinal study will evaluate hospitalized adults with confirmed malignancy and an expected hospital stay of ≥5 days. Daily handgrip strength and sEMG assessments will be performed as exploratory secondary measures to characterize temporal patterns of muscle function during hospitalization. Baseline and discharge evaluations will additionally include bioelectrical impedance analysis, validated patient-reported outcome measures (SARC-F, EORTC QLQ-C30, PSQI), and serum biomarkers related to inflammatory and nutritional status. Linear mixed models will be used to evaluate longitudinal changes and associations between functional, electrophysiological, and biochemical parameters. Expected results: The study aims to characterize trajectories of muscle function decline during hospitalization, identify candidate biomarker signatures for cachexia detection, and evaluate neuromuscular fatigue patterns using sEMG. Conclusions: This protocol proposes a feasible multimodal framework for monitoring skeletal muscle deterioration during acute oncology hospitalization and may inform future interventional strategies targeting cancer-related cachexia and sarcopenia. Full article

Sonoplasma treatment (SPT), which combines hydrodynamic cavitation with low-temperature plasma discharge in water, has been proposed as an advanced oxidation process for reducing biological contamination. By generating physical stressors and reactive oxygen species, including hydrogen peroxide (HP), SPT may inactivate microorganisms, but its effects on stress-resistant filamentous fungi remain insufficiently characterized. We examined two phytopathogenic fungi with contrasting pigmentation: melanized Alternaria alternata and hyaline Fusarium solani. Spore suspensions were exposed to direct and indirect SPT at 30 kHz, and viability, biomass accumulation, conidial production, allelopathic activity, and pigmentation-associated spectral responses were assessed immediately after treatment and after storage. Fungus F. solani showed greater susceptibility, with reduced colony-forming capacity and suppressed biomass production, although surviving propagules showed increased sporulation. In contrast, A. alternata maintained viable growth under the tested conditions and showed stimulation of growth-related and reproductive endpoints, together with darker colony pigmentation. These responses are consistent with pigmentation-associated tolerance to SPT-induced physical and oxidative stress, but do not establish melanin as the sole causal mechanism. SPT efficacy against filamentous fungi is therefore species-dependent and may be limited when resistant melanized taxa are present. Full article

Background: There are very few studies on walking recovery, its predictors and impact on survival in oldest-old patients after a hip fracture. Methods: This study is a retrospective review which included all patients older than 95 years admitted with a fragility hip fracture between December 2009 and September 2015 in a tertiary university hospital in Barcelona. Walking ability was assessed using the Functional Ambulation Classification (FAC) prior to admission and 6 months after discharge. The objective of our study is to assess walking recovery and its predictors in oldest-old patients at 6 months after discharge, and to determine whether there was a relationship with short and long-term survival. Results: One hundred and fifty-two patients were included in the study. Prior to the fracture, 78.3% of patients could walk independently, 36.8% after the fracture. A higher previous FAC score (p < 0.001, OR 3.658), absence of delirium during admission (p = 0.010, OR 3.45), and being able to carry out full weight-bearing (p = 0.026, OR 12.705) were associated with better walking recovery. The area under the ROC curve was 0.819 (p < 0.001). Mean survival after discharge was 2.24 years (SD 1.185). Patients with a post-fracture FAC ≥ 3 showed better survival. Conclusions: Predictors of walking recovery in patients with exceptional longevity were a higher previous FAC score, being able to carry out full weight-bearing, and absence of delirium. Patients able to walk unaided within six months of discharge showed better survival. These findings highlight the importance of functional outcomes when assessing prognosis in the oldest-old. Full article

Background/Objectives: Established AECOPD prognostic tools (DECAF, BAP-65, PEARL) predict mortality or readmission rather than length of stay (LOS), and no admission-based instrument specifically targets prolonged hospitalization. We tested whether admission PaCO₂ and the Prognostic Nutritional Index (PNI), reflecting ventilatory failure and nutritional–immune reserve, are independently associated with prolonged LOS and examined their interaction. Methods: In this single-center retrospective cohort, 213 adults hospitalized exclusively for AECOPD were analyzed after excluding concomitant pneumonia, pulmonary embolism, decompensated heart failure, and in-hospital deaths. Prolonged hospitalization was pre-specified as LOS > 7 days. Multivariable logistic regression evaluated admission PaCO₂ (per +10 mmHg) and PNI (per +5 units) with a PaCO₂ × PNI interaction; continuous LOS was modeled by Gamma regression. Discrimination was compared with DECAF using DeLong’s test. Results: Prolonged hospitalization occurred in 83 patients (39.0%). Admission PaCO₂ was independently associated with prolonged LOS (OR 1.52, 95% CI 1.25–1.88; p < 0.001), and PNI showed a borderline association (OR 0.84, 95% CI 0.71–1.00; p = 0.049); their interaction was significant but exploratory (OR 1.16, 95% CI 1.02–1.32; p = 0.025). In Gamma regression, PaCO₂ (RR 1.18 per 10 mmHg) and PNI (RR 0.92 per 5 units) remained associated with LOS. The two-variable model achieved an AUC of 0.682, showing discrimination similar to DECAF in this cohort (AUC 0.695; DeLong p = 0.76), with optimism-corrected AUC 0.672 and calibration slope 0.96. Within moderate hypercapnia (PaCO₂ 45–60 mmHg), the prolonged-LOS rate was 44.4% in low-PNI versus 15.6% in high-PNI patients. Conclusions: In this single-center retrospective cohort of AECOPD patients surviving to discharge, admission PaCO₂ and PNI were jointly associated with prolonged hospitalization, reflecting acute ventilatory burden and nutritional–immune reserve. Using only two admission inputs, the framework showed discrimination similar to DECAF without meaningful reclassification gain (IDI −0.02; NRI 0.02). Given only moderate discrimination (AUC ~ 0.68), external validation is required before clinical use, with the main practical value likely in complementary stratification within moderate hypercapnia. Full article

Background/Objectives: Following heart transplantation (HT), a subset of patients will require an early or late permanent pacemaker (PPM). We explored risk factors and outcomes associated with PPM implantation in this population. Methods: Using the United Network for Organ Sharing (UNOS) database, we identified all adult patients undergoing HT from 2013 to 2023 who received a PPM early (prior to discharge) or late (>6 months post transplant). Propensity score matching (PSM) was used for control cohorts was. Primary outcomes included recipient survival at 30 days and 1 and 5 years. Predictors of early and late PPM, as well as post-PPM mortality, were assessed using Cox and logistic regression models. Kaplan–Meier survival curves were compared using a log-rank test. Results: Following PSM, the early PPM cohort included 354 patients, and the late PPM cohort included 554 patients. Early PPM patients showed similar 30-day and 1- and 5-year survival (p = 0.582, 0.421, and 0.2844 respectively) but lower rates of graft failure (1.1% vs. 4%, p = 0.017) and primary graft dysfunction (PGD) (1.7% vs. 4.2%, p = 0.046). Late PPM patients had reduced survival at 30 days and 1 year but not at 5 years (p < 0.001, p = 0.0023, 0.050 respectively). Neither early nor late PPM was independently associated with increased risk of mortality after HT. Donation after Circulatory Death (DCD) organs were associated with a lower risk of early PPM (aOR = 0.409, p = 0.020). Late PPM patients showed higher rates of PGD (2.5% vs. 0.5%, p = 0.007). Conclusions: Early or late PPM is not an independent risk factor for mortality after HT, but differing short-term morbidity and mortality are observed. Full article

Burn injuries are increasingly recognized as chronic conditions with enduring physical, psychological and social consequences that extend beyond acute survival. This narrative review synthesizes and interpretatively discusses recent evidence on health-related quality of life (HRQoL) in adult burn survivors, focusing on recovery patterns following discharge. Persistent physical sequelae—particularly chronic pain, pruritus, contractures and scarring—remain major determinants of reduced HRQoL, mainly mediated by functional limitation and self-perception. Psychological morbidity is common, with high rates of depression, anxiety and post-traumatic stress disorder, particularly early after injury, although post-traumatic growth may also emerge. Social reintegration, including return to work, is often delayed or incomplete and is influenced by injury severity, mental health status and social support. Recovery trajectories are nonlinear: the greatest improvements occur within the first six months, followed by slower gains up to 18–24 months, after which many patients fail to reach population norms. Pain and psychological symptoms may persist for years. Overall, these findings support a multidisciplinary, longitudinal approach to burn care, emphasizing early risk stratification and rehabilitation to optimize individualized recovery. In this narrative review, we aim to outline the main dimensions of long-term quality of life, with a particular focus on the temporal dynamics of recovery patterns. Full article

Background/Objectives: Therapeutic plasma exchange (TPE) is an extracorporeal treatment used in thrombotic microangiopathies (TMAs) and various autoimmune and neurological disorders. However, data regarding its use during early pregnancy remain limited. This study aimed to evaluate maternal laboratory response and perinatal outcomes in pregnant women who underwent TPE before 26 weeks of gestation. Methods: This retrospective case series included 10 pregnant women diagnosed before 26 weeks of gestation who underwent TPE between 2010 and 2023. Clinical and laboratory parameters before and after TPE were compared. Results: Indications for TPE included HELLP syndrome (n = 4), thrombotic thrombocytopenic purpura (n = 3), presumed atypical haemolytic uremic syndrome (n = 1), neuromyelitis optica (n = 1), and Guillain–Barré syndrome (n = 1). The mean gestational age at diagnosis was 22.1 ± 3.1 weeks, and the mean gestational age at delivery was 27.1 ± 6.9 weeks. Five fetuses (50%) died and five (50%) survived to discharge. In patients with TMAs, TPE was associated with significant decreases in LDH, INR, APTT, ALT, AST, and total bilirubin levels, along with a significant increase in platelet count and ADAMTS13 activity (p < 0.01). No maternal complications occurred in neurological cases, all of which resulted in term deliveries with healthy neonates. Conclusions: In this uncontrolled case series, TPE was associated with rapid maternal clinical and laboratory improvement in selected pregnant women with TMAs, although a causal effect cannot be established from these data. However, perinatal outcomes were primarily determined by gestational age at delivery: all fetal losses occurred before 26 weeks, whereas all infants survived when delivery occurred after 26 weeks. Larger studies are needed to confirm these findings. Full article

Background/Objectives: Intranasal tumors are common malignancies in dogs, characterized by locally aggressive behavior and clinical signs such as epistaxis, nasal discharge, and facial deformity. Radiotherapy (RT) is considered the treatment of choice due to anatomical limitations to surgical resection. This study aimed to evaluate clinical outcomes, toxicity, and prognostic factors in dogs with primary malignant intranasal tumors treated with cobalt-60–based megavoltage radiotherapy. Methods: This retrospective study included 40 dogs with histopathologically confirmed primary malignant intranasal tumors treated between September 2018 and February 2025 at a veterinary radiotherapy clinic in Rio de Janeiro, Brazil. Medical records were reviewed for patient demographics, tumor characteristics, treatment protocols, response, toxicity, and survival outcomes. Tumors were staged using modified Adams criteria based on computed tomography. Definitive-intent protocols (n = 32) delivered 48–54 Gy in 10–13 fractions administered three to five times weekly, while palliative protocols consisted of either four fractions of 8 Gy delivered once weekly or five fractions of 4 Gy delivered daily. Results: Adenocarcinoma was the most common histologic subtype (42.5%), and 82.5% of dogs had stage III–IV disease. The objective response rate was 82.5% (CR: 17.5%; PR: 65.0%), with clinical benefit observed in 92.5% of cases. Acute toxicity was frequent but manageable, primarily affecting skin, oral mucosa, and eyes. Overall median progression-free interval (PFI) and survival time (MST) were 382 days and 430 days, respectively. Stage IV disease was significantly associated with shorter survival when compared to stage I-III (MST 345 vs. 1063 days, respectively; p = 0.016). Treatment response was significantly associated with PFI in univariate analysis (p < 0.05). Conclusions: Radiotherapy provided high response rates and meaningful clinical benefit with acceptable toxicity in dogs with malignant intranasal tumors, highlighting the importance of early diagnosis and treatment. Further prospective studies with standardized protocols are warranted. Full article

Background: Effective root canal disinfection is essential for successful nonsurgical root canal treatment (RCT). Although sodium hypochlorite (NaOCl) remains the standard irrigant, it carries a risk of chemical tissue injury if extruded beyond the root canal system and may have limited penetration into anatomically complex regions. Underwater discharge plasma (UDP) generates reactive oxygen and nitrogen species (RONS) through high-frequency, high-voltage electrical discharge in aqueous media, and preclinical and in vitro studies have reported broad-spectrum antimicrobial activity. This study evaluated the clinical and radiographic outcomes of nonsurgical RCT performed using physiological saline-based UDP irrigation without NaOCl in a heterogeneous real-world clinical cohort. Methods: This single-center retrospective cohort study included 186 teeth from 134 patients treated with the PLAZEN RCT^® UDP device and physiological saline irrigation, without NaOCl. The median follow-up period was 16 months. Radiographic outcomes were assessed using the Periapical Index (PAI) system, and treatment success was evaluated according to prespecified Strict and Loose criteria incorporating both radiographic and clinical findings. Stratified analysis was performed according to preoperative PAI score: Group A (PAI 1–2) and Group B (PAI 3–5). UDP-related adverse events, defined as thermal tissue injury caused by discharge heat, were ascertained through retrospective review of clinical records, operative notes, and serial periapical radiographs. Results: Among the 186 treated teeth, radiographic outcomes were classified as Healed (85.5%), Healing (3.8%), and Unhealed (10.8%). Overall Strict and Loose success rates were 79.6% and 82.3%, respectively. Initial treatment showed numerically higher success rates than retreatment. In the stratified analysis, Group A showed an 84.1% success rate with 100% tooth survival, whereas Group B demonstrated Strict and Loose success rates of 68.5% and 83.3%, respectively. Exploratory multivariable analysis showed that periodontal pocket depth > 3 mm was the most consistent factor associated with lower odds of treatment success, whereas associations involving canal obliteration and higher preoperative PAI score were less stable across sensitivity analyses and should be interpreted with caution. No UDP-related adverse events were recorded during follow-up. Attrition sensitivity analyses were performed, and the outcome estimates should be interpreted with caution, given the retrospective design and substantial loss to follow-up. Conclusions: In this preliminary observational cohort, physiological saline-based UDP irrigation without NaOCl was associated with favorable observed periapical healing outcomes and no recorded UDP-related adverse events over a median follow-up of 16 months. However, loss to follow-up was substantial; when all 116 teeth lost to follow-up were classified as treatment failures, the worst-case Strict success rate decreased to 49.0%. Therefore, these findings should be interpreted as preliminary descriptive evidence of clinical feasibility rather than as evidence of comparative efficacy or definitive clinical safety. Adequately powered randomized controlled trials with concurrent NaOCl control arms and long-term follow-up are warranted to evaluate the comparative effectiveness, safety, and reproducibility of physiological saline-based UDP irrigation protocols. Full article

Objectives: To describe the clinical, clinicopathological and ultrasonographic characteristics of dogs with an acute pancreatitis (AP) and to identify prognostic markers associated with short-term mortality in a referral population. Methods: This retrospective observational study included 192 dogs hospitalised with AP at a referral centre in Spain between 2021 and 2024. Dogs were classified as survivors or non-survivors based on survival to hospital discharge. Signalment, clinical findings, clinicopathological and ultrasonographic variables, comorbidities, treatments and duration of hospitalisation were recorded. Variables associated with outcome in univariable analyses were entered into a multivariable logistic regression model to identify independent predictors of death. Results: Of the 192 dogs, 141 (73.4%) survived and 51 (26.6%) died or were euthanised during hospitalisation. Non-survivors had higher serum creatinine, total bilirubin and alkaline phosphatase (ALKP) concentrations than survivors. In multivariable analysis, increased serum creatinine (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.32–4.11), total bilirubin (OR 1.42; 95% CI 1.03–2.06) and ALKP (OR 1.52; 95% CI 1.07–2.16) were independently associated with an increased risk of short-term mortality. Ultrasonographic abnormalities compatible with AP were identified in 121 dogs (63%), but were not independently associated with short-term mortality. Breed, age, sex, body weight, comorbidities and treatments were not associated with outcome. Clinical Significance: Measurement of serum creatinine, total bilirubin and ALKP concentrations at presentation may help identify dogs with AP at increased risk of death. Early recognition of high-risk patients may assist clinical decision-making, guide the intensity of monitoring, and facilitate communication with owners. Full article

Background/Objectives: Successful revascularization following extremity arterial injury is critical for survival and limb salvage. Graft repair is required in ~45% of patients, with the autologous vein preferred for its efficacy and safety. When unavailable, synthetic or non-autologous grafts are associated with infection, amputation, and reduced durability. Extremity arterial injury-specific cost data are lacking, with estimates extrapolated from the general trauma literature. This study characterized the costs and post-discharge healthcare resource utilization (HCRU) for U.S. adults with extremity arterial injury undergoing graft repair. Methods: Adults with extremity arterial injury undergoing graft repair (January 2018 to March 2023) were identified from the linked PINC AI Healthcare Database and Inovalon all-payer claims. Hospitalization charges, costs, and 18-month post-discharge HCRU and costs were assessed. Two-part models estimated cost drivers, adjusted for demographics, clinical characteristics, and complications. Results: Among 964 patients, grafts were autologous (74%), synthetic (14%), other (6%), or multiple (6%). Mean initial hospitalization charges and reimbursed costs were $316,600 and $75,947, respectively. Charges/costs increased with orthopedic fracture (+$639,558/+$91,462), graft infection (+$589,921/+$84,598), and amputation (+$492,986/+$116,611) (all p < 0.05). Mean post-discharge costs were $70,222 at 6 months and $93,639 at 18 months. Initial hospitalization complications predicted increased post-discharge costs: orthopedic fracture ($138,683–$145,360) and graft infection ($389,376–$422,224) (both p < 0.01). Post-discharge aneurysm, graft infection, and thrombectomy were also associated with higher costs (all p < 0.05). Post-discharge HCRU was lowest and most stable with the autologous vein. Conclusions: In-hospital and post-discharge complications are major cost drivers following arterial graft repair. Graft infection was associated with significantly increased costs across both periods, and non-autologous graft use was associated with disproportionately higher 18-month HCRU. Full article