Contemporary Outcomes of Peripheral Bypass Compared with Amputation in Octogenarians.

Abstract:

BACKGROUND:Chronic limb threatening ischemia in octogenarians presents unique treatment challenges in patients with multiple comorbidities and variable functional status. Endovascular interventions offer a better risk profile; however, this is not always a feasible option for anatomic or disease-specific reasons. This study compares outcomes of peripheral bypass versus amputation in octogenarians. METHODS:The American College of Surgeon's National Surgical Quality Improvement Program database was queried from 2013 to 2016 for patients >80 years undergoing femoral-popliteal bypass (FPB), femoral-tibial bypass, or popliteal-tibial bypass with vein or prosthetic graft versus above-knee amputation (AKA) or below-knee amputation. Patients presenting with systemic inflammatory response syndrome, sepsis, septic shock, or a leukocytosis >11,000 were excluded. Patient demographics, risk factors, and 30-day unadjusted outcomes were analyzed. Multivariate regression analysis was then performed to compare risk adjusted 30-day morbidity and mortality. RESULTS:The bypass group contained 2226 patients compared with 1253 patients in the amputation group. AKA represented 59.9% of the amputation group. The largest portion of bypasses were FPBs at 58.6%. Total preoperative functional dependence was 1.3% for bypass versus 18.2% for amputation (P-value, <0.01). Risk factors for amputation over bypass included age, minority race, American Society of Anesthesiologists class IV-V, diabetes, congestive heart failure, dialysis, preoperative open wound, facility of origin, and functional dependence. Unadjusted 30-day mortality was 3.6% for bypasses and 7.7% for amputations (P-value, <0.01), with an in-hospital mortality of 2.0% vs. 3.2% and a mortality after discharge of 1.6% vs. 4.5%, respectively (P-value <0.01). Unadjusted morbidity was not significantly different between the 2 groups (18.7% bypass vs. 17.8% amputation, P-value, 0.52). After multivariate risk adjustment, there was no statistically significant difference in mortality or morbidity between the groups. CONCLUSIONS:Contemporary risk-adjusted 30-day morbidity and mortality for bypass versus amputation in octogenarians show no significant difference. These data demonstrate that aggressive surgical limb salvage can be safe in well-selected patients in this age group.

journal_name

Ann Vasc Surg

authors

Madabhushi V,Richie C,Bettis A,Davenport D,Orr N

doi

10.1016/j.avsg.2020.08.094

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

56-61

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(20)30774-3

journal_volume

70

pub_type

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