bypass is associated with lower perioperative mortality than major amputation in high-risk surgical candidates

Leg Ischemia and Aortoiliac Disease


Infrainguinal bypass is associated with lower perioperative mortality than major amputation in high-risk surgical candidates


Barshes NR, Menard MT, Nguyen LL, et al (Brigham and Women’s Hosp, Boston, MA) J Vasc Surg 53:1251–1259, 2011§



J.D. Raffetto, MD



Evidence Ranking


• B



Expert Rating


• 2



Abstract



Background


Major amputation is often selected over infrainguinal bypass in patients with severe systemic comorbidities because it is assumed to have lower perioperative risks, yet this assumption is unproven and largely unexamined.



Methods


The 2005 to 2008 National Surgical Quality Improvement Project (NSQIP) database was used to identify all patients undergoing either infrainguinal bypass or major amputation using procedural codes. Patients with systemic or local infections were excluded. A subset of high-risk patients were then defined as American Society of Anesthesiologists (ASA) class 4 or 5, or ASA class 3 with renal failure, dyspnea at rest, ventilator dependence, recent congestive heart failure, or recent myocardial infarct. Propensity score matching was used to obtain two high-risk patient groups matched for preoperative characteristics.



Results


No significant differences in demographic, preoperative, or anesthetic variables were found between the matched, high-risk amputation or bypass groups (792 and 780 patients, respectively). Bypass was associated with a lower 30-day postoperative mortality than amputation (6.54% vs 9.97%; P = .0147). Amputation was associated with higher rates of pulmonary embolism (0.9% vs 0% for amputation vs bypass groups, respectively; P = .009) and urinary tract infection (5.2% vs 2.7%; P = .01), while bypass was associated with higher rates of return to the operating room (14.1% vs 27.6%; P < .001) and a trend toward higher postoperative transfusion requirements (0.9% vs 2.1%; P = .054). The postoperative time to discharge did not differ between the two groups.

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Apr 1, 2017 | Posted by in CARDIOLOGY | Comments Off on bypass is associated with lower perioperative mortality than major amputation in high-risk surgical candidates

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