Preoperative functional status predicts perioperative outcomes after infrainguinal bypass surgery

Objective Infrainguinal surgical bypass (BPG) is a durable method for lower extremity revascularization, but is accompanied by significant 30-day morbidity and mortality (MM). The goal of this study is to relate preoperative functional status, a defined metric in the National Surgical Quality Improv...

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Bibliographic Details
Published in:Journal of vascular surgery 2010-02, Vol.51 (2), p.351-359
Main Authors: Crawford, Robert S., MD, Cambria, Richard P., MD, Abularrage, Christopher J., MD, Conrad, Mark F., MD, Lancaster, Robert T., MD, Watkins, Michael T., MD, LaMuraglia, Glenn M., MD
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Critical Illness
Databases as Topic
Diabetes Complications - surgery
Female
Health Status Indicators
Humans
Intermittent Claudication - etiology
Intermittent Claudication - mortality
Intermittent Claudication - surgery
Ischemia - etiology
Ischemia - mortality
Ischemia - surgery
Kidney Diseases - complications
Kidney Diseases - therapy
Logistic Models
Lower Extremity - blood supply
Male
Middle Aged
Odds Ratio
Patient Selection
Peripheral Vascular Diseases - complications
Peripheral Vascular Diseases - mortality
Peripheral Vascular Diseases - surgery
Predictive Value of Tests
Pulmonary Disease, Chronic Obstructive - complications
Renal Dialysis
Risk Assessment
Risk Factors
Surgery
Time Factors
Treatment Outcome
United States - epidemiology
Vascular Surgical Procedures - adverse effects
Vascular Surgical Procedures - mortality
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Summary:Objective Infrainguinal surgical bypass (BPG) is a durable method for lower extremity revascularization, but is accompanied by significant 30-day morbidity and mortality (MM). The goal of this study is to relate preoperative functional status, a defined metric in the National Surgical Quality Improvement Program (NSQIP) database, to perioperative MM. Methods Between January 1, 2005 and December 31, 2007, all patients who underwent BPG from the NSQIP private sector database were reviewed. The primary end-point was 30-day MM. Patients were stratified by preoperative functional status: independent (IND) vs dependent (DEP). Associated patient demographic/clinical data were analyzed using univariate and multivariate methods. Composite odds ratios were constructed with clusters of high-risk comorbidities. Results There were 5639 BPG patients (4600 [81.6%] IND and 1039 [18.4%]) DEP. DEP patients were significantly older (71.6 ± 11.8 vs 66.8 ± 11.8 years; P < .0001), had more chronic obstructive pulmonary disease (COPD) (16.7% vs 11.4%; P < .0001), diabetes (54.2% vs 40.7%; P < .0001), dialysis dependence (16.4% vs 5.6%; P < .0001), and critical limb ischemia (64.6% vs 44.0%; P < .0001). DEP patients had a higher incidence of death (6.1% vs 1.5%; P < .0001) and major complications (30.3% vs 14.2%; P < .0001). DEP was an independent predictor of major complications (odds ratio [OR]: 2.0; 95% confidence interval [CI]: [1.7-2.4]; P < .0001) major systemic complications (2.5 [1.9-3.2]; P < .0001), major operative site complications (1.6 [1.4-1.9]; P < .0001) and death (2.3[1.6-3.4]; P < .0001). The combination of DEP with emergency surgery, Cr > 1.8, or rest pain increased the odds of major complications by five, seven, or 11-fold, respectively. The combination of DEP with hemodialysis, emergency surgery, or age ≥80 years increased the odds of death by 13, 38, or 87-fold, respectively. Conclusion Preoperative DEP is significantly correlated with all adverse 30-day outcomes in BPG patients. Furthermore, when combined in high-risk composites with specific preoperative clinical variables, DEP is associated with prohibitive MM, thereby identifying patient cohorts that may be unsuitable for BPG.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2009.08.065