Goshima Kaoru Ruth, Mills Joseph L, Hughes John D
Vascular Surgery Section, University of Arizona Health Sciences Center, Tucson, AZ 70121, USA.
J Vasc Surg. 2004 Feb;39(2):330-5. doi: 10.1016/j.jvs.2003.10.020.
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.
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.
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.
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.
移植血管通畅率、肢体挽救率和死亡率是评估腹股沟下旁路手术（IBS）疗效的传统指标。然而，这些指标低估了患者的发病率，且未考虑使患者恢复到病前状态所需的全部治疗范围。本研究的目的是通过评估三个非传统指标来量化实现肢体挽救所需的努力：（1）3个月内的靶肢体再次手术率；（2）IBS后前6个月内的医院再入院率；（3）伤口愈合时间。
我们回顾性分析了在单一机构进行的318例IBS。记录了因肢体或移植相关问题进行的再次手术以及初次手术后6个月内的再入院情况。如有可用数据，确定伤口愈合时间。对相关的人口统计学和合并症进行单因素和多因素分析，以确定不良结局的危险因素。
72%的患者因严重肢体缺血（CLI）接受IBS，84%的患者接受了膝下腘动脉或远端旁路手术。在因CLI接受IBS的患者中，48.9%的患者在3个月内至少需要进行一次再次手术。在6个月内，49.3%的患者需要再次入院。54%的患者伤口愈合时间超过3个月。多因素分析后，组织缺损和少数族裔身份是3个月内再次手术的显著危险因素。组织缺损和肾衰竭增加了6个月内再次入院的几率。糖尿病是伤口愈合时间延长的唯一危险因素。
为挽救肢体进行的IBS常因恢复时间延长、多次再次手术和再入院而复杂化。肢体挽救手术的传统报告标准需要修改，以反映此类手术的真实疗效。
