Perioperative outcomes and amputation-free survival after lower extremity bypass surgery in California hospitals, 1996-1999, with follow-up through 2004

Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter (Impact Factor: 3.02). 08/2009; 50(4):776-783.e1. DOI: 10.1016/j.jvs.2009.05.050
Source: PubMed


There are very few population-based studies of long-term outcomes after lower extremity (LE) bypass graft surgery. This study analyzes perioperative and long-term limb salvage and amputation-free survival outcomes for patients undergoing initial aortoiliac or femoropopliteal bypass graft surgery in California hospitals from 1996 to 1999.
Administrative data with encrypted identifiers were used to identify a chronologically first, index admission of all patients undergoing LE bypass procedures for occlusive disease from 1996 to 1999. A 1993 to 1995 look-back period was used to exclude patients who had undergone prior bypass surgery or amputation procedures. Patients with incident procedures were then followed forward to determine subsequent hospitalizations and vital status through 2004. The study comprised 28,128 patients discharged from 345 California hospitals with a median 61.5-month follow-up. Risk factors included demographic characteristics, comorbid conditions, admission type, gangrene or ulceration, operation level, hospital LE bypass surgery volume, and year of discharge. Logistic regression was used to analyze 30-day outcomes, and Kaplan-Meier analysis and Cox proportional hazard models were used to analyze amputation-free survival.
Overall 30-day mortality was 4.3, and the 30-day major amputation rate was 2.6%. Limb salvage was 81.9% at 5 years and 76.4% at 9 years. Amputation-free survival was 51.5% at 5 years and 34.1% at 9 years. Risk factors were generally similar for both perioperative and late outcomes. Advanced age, higher comorbidity level, gangrene, and emergency or nursing home admission conferred significantly greater risk. Hospital volume was associated with both perioperative and late outcomes. African American and Hispanic patients had much higher amputation rates but did not have higher mortality risk after controlling for baseline severity of illness.
Long-term outcomes of LE bypass surgery were superior for high-volume hospital patients. Graft surveillance and risk factor follow-up care provide a major opportunity for quality improvement efforts. The contrast between traditional limb salvage and amputation-free survival outcomes raises questions about the value of surgical treatment, particularly for patients with limited life expectancy and without coding of tissue loss or critical limb ischemia.

Download full-text


Available from: Gary J Martin, Oct 19, 2015
29 Reads
  • Source
    • "In the United States, ischemic cardiovascular diseases are the number one cause of death [1]. Although numerous pharmacological and surgical therapies have been developed, many of the patients still exhibit grave symptoms and continue to show increasing heart failure or advance critical limb ischemia and the need for hospitalization [2-4]. Due to our limited therapeutic options, the demand for novel methods of treatment for ischemic cardiovascular diseases has been increasing. "
    [Show abstract] [Hide abstract]
    ABSTRACT: While bone marrow (BM)-derived cells have been comprehensively studied for their propitious pre-clinical results, clinical trials have shown controversial outcomes. Unlike previously acknowledged, more recent studies have now confirmed that humoral and paracrine effects are the key mechanisms for tissue regeneration and functional recovery, instead of transdifferentiation of BM-derived cells into cardiovascular tissues. The progression of the understanding of BM-derived cells has further led to exploring efficient methods to isolate and obtain, without mobilization, sufficient number of cell populations that would eventually have a higher therapeutic potential. As such, hematopoietic CD31(+) cells, prevalent in both bone marrow and peripheral blood, have been discovered, in recent studies, to have angiogenic and vasculogenic activities and to show strong potential for therapeutic neovascularization in ischemic tissues. This article will discuss recent advancement on BM-derived cell therapy and the implication of newly discovered CD31(+) cells.
    Blood Research 06/2013; 48(2):76-86. DOI:10.5045/br.2013.48.2.76
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: NMR is a rapidly developing modality with proven diagnostic potential. The wealth of information involved suggests that computers can play a valuable role in the analysis of NMR images beyond the common uses of acquisition, reconstruction, storage and display. Applications in the area of relaxation time images, calculated intensity images, flow images and tissue type maps are described.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Log periodic designs are a well established wide-band antenna technology, but one in which the phase center travels along the structure as the frequency varies. When a log periodic antenna is used as a feed for a reflector antenna, the phase center location cannot be maintained at the reflector focus over the frequency range and defocusing results. The purpose of this analysis is to quantify the defocusing loss for a log periodicfed reflector. The analysis presented compares favorably with measured results.
    IEEE Transactions on Antennas and Propagation 08/1985; 33(7-33):809 - 812. DOI:10.1109/TAP.1985.1143659 · 2.18 Impact Factor
Show more