Pre-operative predictors of poor outcomes in patients undergoing surgical lower extremity revascularisation - Retrospective cohort study.
BACKGROUND
Surgical lower extremity revascularisation (LER) can lead to poor outcomes that include delayed hospital discharge, in-hospital mortality, major amputations and readmissions. The aim of this study was to identify pre-operative predictors associated with these poor clinical outcomes.


METHODS
All patients (n = 635; mean age 69; male 67.4%) who underwent surgical LER over a 5 year period in a single tertiary vascular institution were identified. Patients considered to have suffered a poor outcome (Group A) included all in-hospital mortality and major amputations, delayed discharges with a length of stay (LOS) over one standard deviation above the mean or any readmission under any specialty within 12 months. Group A included 247 patients (38.9%) and the good outcome group included the remaining 388 patients (61.1%) from which a sample of 99 patients were selected as controls (Group B).


RESULTS
Mean LOS for the entire study group was 14.4 ± 17.5 days, 12 month readmission rate was 29.1% and in-hospital mortality and major amputation rate was 2.7% and 1.4%, respectively. Pre-admission residence other than own home (OR 9.0; 95% CI 1.2-70.1; P = 0.036), atherosclerotic disease burden (OR 2.2; 95% CI 1.3-3.8; P = 0.003) and tissue loss (OR 3.0; 95% CI 1.6-5.3; P < 0.001) were identified as independent, statistically significant pre-operative predictors of poor outcome. Following discharge, group B patients had a significantly higher rate of amputation free survival and graft infection free survival (P < 0.001) compared to group A.


CONCLUSIONS
Recognition of pre-operative predictors of poor outcome should inform case selection and identify high risk patients requiring intensive perioperative optimisation and post discharge follow up.
Department of Vascular and Endovascular Surgery, University Hospital of South Manchester, Manchester, UK.
Mohammed
M
Ashrafi
Department of Vascular and Endovascular Surgery, University Hospital of South Manchester, Manchester, UK.
Rohini
R
Salvadi
Department of Medical Statistics, University Hospital of South Manchester, Manchester, UK.
Philip
P
Foden
Department of Microbiology, University Hospital of South Manchester, Manchester, UK.
Stephanie
S
Thomas
Department of Vascular and Endovascular Surgery, University Hospital of South Manchester, Manchester, UK. Electronic address: m.baguneid@nhs.net.
Mohamed
M
Baguneid
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D050197:Atherosclerosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects* / Q000379:methods
Poor outcomes; Pre-operative predictors; Surgical lower extremity revascularisation