title: The effect of ambulatory status on outcomes of percutaneous vascular interventions and lower extremity bypass for critical limb ischemia in the Vascular Quality Initiative.
abstract: Ambulatory status has been shown to be an important predictor of postoperative morbidity and mortality for a variety of surgical procedures. We sought to assess contemporary practice patterns in treating critical limb ischemia (CLI) and outcomes based on ambulatory status.
  
  
  
  The Vascular Quality Initiative (2010-2015) was queried for patients undergoing percutaneous vascular interventions (PVIs) or lower extremity bypass (LEB) for CLI. Ambulatory status was classified as ambulatory, ambulatory with assistance, and nonambulatory (composite of wheelchair bound and bedridden). Perioperative and postoperative outcomes were recorded. Multivariable analyses were performed to identify the effect of ambulatory status.
  
  
  
  There were 11,522 ambulatory (PVI, 63%; LEB, 37%), 4443 ambulatory with assistance (PVI, 67%; LEB, 33%), and 1732 nonambulatory (PVI, 77%; LEB, 23%) patients with CLI treated (P < .01 across ambulatory status groups). Perioperative mortality for PVI and LEB for ambulatory, ambulatory with assistance, and nonambulatory status was 1.5% and 1.7%, 3.0% and 3.1%, and 4.7% and 4.9%, respectively (P < .01 across ambulatory status groups). Worsening ambulatory status was associated with higher perioperative complications with PVI and LEB. Multivariable analysis showed that worsening ambulatory status predicted higher postprocedural mortality, amputation or death, and major adverse limb events or death.
  
  
  
  In the Vascular Quality Initiative, as ambulatory status declines, perioperative morbidity and mortality increase. Impaired ambulatory patients are more likely to receive PVI than LEB for the treatment of CLI, although even among nonambulatory patients, there are still a significant number who receive LEB.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Lu
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.affiliation: Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Virendra I
authors.initials: VI
authors.lastname: Patel
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kalish
authors.affiliation: Department of Biostatistics, Boston University, Boston, Mass.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Department of Biostatistics, Boston University, Boston, Mass.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass. Electronic address: Jeffrey.siracuse@bmc.org.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D016638:Critical Illness; D016208:Databases, Factual; D051341:Dependent Ambulation; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality