title: A new look at outcomes after infrainguinal bypass surgery: traditional reporting standards systematically underestimate the expenditure of effort required to attain limb salvage.
abstract: BACKGROUND
  Graft patency, limb salvage, and mortality are the traditional means of assessing the outcome of infrainguinal bypass surgery (IBS). However, these measures underestimate patient morbidity and fail to consider the entire spectrum of treatment required to restore the patients to their premorbid state. The aim of this study was to quantify the efforts required to achieve limb salvage by assessing three nontraditional outcomes: (1). index limb reoperation rate in 3 months, (2). hospital readmission rate in the first 6 months after IBS, and (3). wound-healing time.
  
  
  METHODS
  We retrospectively analyzed 318 IBSs performed at a single institution. Repeat operations for limb or graft-related problems and readmissions within 6 months of the initial operation were recorded. When available, wound-healing time was determined. Pertinent demographics and comorbidities were subjected to univariate and multivariate analysis to determine risk factors for adverse outcomes.
  
  
  RESULTS
  Seventy-two percent of patients underwent IBS for critical limb ischemia (CLI), and 84% had below-knee popliteal or distal bypasses. Among those who underwent IBS for CLI, 48.9% of patients required at least one reoperation within 3 months. Within 6 months, 49.3% of patients required hospital readmission. Time to heal exceeded 3 months in 54% of patients. After multivariate analysis, tissue loss and minority status were significant risk factors for reoperation within 3 months. Tissue loss and renal failure increased the odds for readmission within 6 months. Diabetes was the sole risk factor for prolonged wound healing.
  
  
  CONCLUSIONS
  IBS for limb salvage is often complicated by prolonged recovery and multiple reoperations and readmissions. Traditional reporting standards for limb salvage operations need modification to reflect the true outcome of such procedures.
authors.affiliation: Vascular Surgery Section, University of Arizona Health Sciences Center, Tucson, AZ 70121, USA.
authors.forename: Kaoru Ruth
authors.initials: KR
authors.lastname: Goshima
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Mills
authors.forename: John D
authors.initials: JD
authors.lastname: Hughes
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D010359:Patient Readmission / Q000706:statistics & numerical data; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors; D014945:Wound Healing