title: Outcomes of surgical revascularization for lower extremity arterial thromboembolism in patients with advanced malignancy.
abstract: OBJECTIVE
  The objective of this study was to describe the outcomes of surgical revascularization for lower extremity arterial thromboembolism in patients with advanced malignancy.
  
  
  METHODS
  The 2005-2011 American College of Surgeons National Surgical Quality Improvement Program database was used for this study. Preoperative characteristics and postoperative outcomes of patients with known advanced malignancy who underwent surgical revascularization for lower extremity arterial thromboembolic disease were assessed and compared with those of patients without known advanced malignancy. Parsimonious multivariate logistic regression analysis was used to determine the independent association between advanced malignancy and 30-day postoperative mortality and morbidity after adjustment for demographic characteristics, acute and chronic comorbid disease burden, history of peripheral arterial disease, functional and nutritional status, acuity of presentation, and procedure type.
  
  
  RESULTS
  The study included 136 patients with advanced malignancy who underwent surgical revascularization for lower extremity arterial thromboembolism for analysis (65% thromboembolectomy, 26% thromboendarterectomy, and 22% bypass grafting). The 30-day mortality and morbidity rates in these patients were 30.2% and 38.2%, respectively. Compared with patients without advanced malignancy, patients with advanced malignancy had a significantly greater risk of postoperative death (adjusted odds ratio, 5.92; 95% confidence interval, 3.69-9.52; P < .001) but not morbidity (adjusted odds ratio, 1.28; 95% confidence interval, 0.87-1.87; P = .21).
  
  
  CONCLUSIONS
  Our study is the largest to date to describe the outcomes of patients with advanced malignancy who undergo surgical revascularization for arterial thromboembolism of the lower extremities. Such patients suffer high rates of early postoperative mortality and morbidity, especially when emergency operation is required. Early involvement of palliative care specialists is warranted in these patients to ensure that the decision to pursue surgical revascularization is aligned with their goals of care.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC. Electronic address: benne051@mc.duke.edu.
authors.forename: Kyla M
authors.initials: KM
authors.lastname: Bennett
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Shortell
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Cox
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013923:Thromboembolism / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods*