Jorshery Saman Doroodgar, Skrip Laura, Sarac Timur, Ochoa Chaar Cassius Iyad
Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
Yale School of Public Health, New Haven, Conn.
J Vasc Surg. 2018 Nov;68(5):1447-1454.e5. doi: 10.1016/j.jvs.2018.01.058.
Hybrid procedures have gained momentum as less invasive operations that can potentially improve outcomes for patients. However, there is a paucity of data comparing hybrid procedures with traditional bypass. This study compares the perioperative outcomes of hybrid and bypass surgery for femoropopliteal (FP) revascularization.
The American College of Surgeons National Surgical Quality Improvement Program files (2012-2015) were reviewed, and three groups of patients undergoing isolated FP revascularization were identified by Current Procedural Terminology codes. All patients underwent femoral endarterectomy. The hybrid group (HYB) had a concomitant antegrade endovascular FP intervention and was compared with patients with concomitant FP bypass with vein (BPV) and FP bypass with nonvein graft (BPG). The demographics, comorbidities, and outcomes of the three groups were analyzed. The χ and analysis of variance tests with post hoc analysis were used. A multivariable logistic regression analysis was performed to identify predictors of readmission, reoperation, and mortality.
There were 1480 patients in the analysis. Compared with patients undergoing BPV and BPG, patients in the HYB group tended to be older (P = .016) and were less likely to be smokers (P < .001). They had fewer infected wounds (P = .001) and were more likely to have American Society of Anesthesiologists score ≤3 (P = .01) and claudication (P < .01). HYB patients had significantly fewer bleeding transfusions (P = .01) and less overall morbidity (P < .001) compared with BPV and BPG patients. The three treatment groups did not differ in frequencies of mortality and major amputation. Among the groups, BPV was associated with the longest operating time (P < .001), whereas HYB had significantly shorter hospital stay (P < .001). HYB was also associated with significantly lower rates of reoperation (P = .017) and readmission (P = .007). On multivariable regression, patients undergoing BPG were at increased risk of readmission (odds ratio [OR], 1.48 [1.00-2.17]) compared with HYB. HYB surgery was associated with less morbidity compared with BPV (OR, 1.38 [1-1.9]) and BPG (OR, 1.77 [1.3-2.38]).
Hybrid procedures have favorable perioperative outcomes compared with open bypass for FP revascularization. Additional research on the long-term outcomes of hybrid procedures is needed.
混合手术作为一种侵入性较小的手术方式，已获得越来越多的关注，其有可能改善患者的治疗效果。然而，将混合手术与传统搭桥手术进行比较的数据却很匮乏。本研究比较了混合手术和旁路手术治疗股腘动脉（FP）血管重建的围手术期结果。
回顾了美国外科医师学会国家外科质量改进计划档案（2012 - 2015年），并根据现行手术操作术语编码确定了三组接受单纯FP血管重建的患者。所有患者均接受了股动脉内膜切除术。混合组（HYB）同时进行了顺行性血管内FP干预，并与同时进行静脉FP搭桥（BPV）和非静脉移植物FP搭桥（BPG）的患者进行比较。分析了三组患者的人口统计学、合并症和治疗结果。采用χ检验和方差分析以及事后分析。进行多变量逻辑回归分析以确定再入院、再次手术和死亡率的预测因素。
分析中共有1480例患者。与接受BPV和BPG的患者相比，HYB组患者年龄往往更大（P = 0.016），吸烟的可能性更小（P < 0.001）。他们的感染伤口更少（P = 0.001），美国麻醉医师协会评分≤3分（P = 0.01）和间歇性跛行的可能性更大（P < 0.01）。与BPV和BPG患者相比，HYB患者的输血次数显著减少（P = 0.01），总体发病率更低（P < 0.001）。三组治疗在死亡率和大截肢频率方面没有差异。在这些组中，BPV的手术时间最长（P < 0.001），而HYB的住院时间显著缩短（P < 0.001）。HYB的再次手术率（P = 0.017）和再入院率（P = 0.007）也显著更低。在多变量回归分析中，与HYB相比，接受BPG的患者再入院风险增加（比值比[OR]，1.48[1.00 - 2.17]）。与BPV（OR，1.38[1 - 1.9]）和BPG（OR，1.77[1.3 - 2.38]）相比，HYB手术的发病率更低。
与开放性旁路手术治疗FP血管重建相比，混合手术具有良好的围手术期结果。需要对混合手术的长期结果进行更多研究。
