Division of Vascular Surgery, Yale University School of Medicine, New Haven, CT.
Division of Vascular Surgery, Yale University School of Medicine, New Haven, CT.
Ann Vasc Surg. 2021 Jan;70:237-244. doi: 10.1016/j.avsg.2020.06.057. Epub 2020 Jul 10.
Chronic limb-threatening ischemia (CLTI) manifests as rest pain (RP) and tissue loss (TL). Outcomes of lower extremity revascularization (LER) for CLTI have traditionally been evaluated as a single entity and compared with claudication. We hypothesize that patients presenting with TL have worse short-term outcomes after LER, compared to patients with RP.
The National Inpatient Sample was reviewed between 2009 and 2013. All patients undergoing LER for TL and RP were identified. Patient characteristics, Charlson Comorbidity Index (CCI), length of stay, rates of inpatient major amputation, and mortality after LER were noted. Multivariable regression analysis was performed to identify predictors of inpatient mortality and major amputation between the 2 groups.
A total of 218,628 patients underwent LER (RP = 76,108, TL = 142,519). Patients with TL were more likely to undergo endovascular LER (RP = 31.3% vs. TL = 48.7%; P < 0.001). Patients with TL had higher comorbidities as suggested by increased likelihood of having CCI ≥3 (RP = 22.9% vs. TL = 40.3%; P < 0.001). The mean costs were significantly higher in the TL group (RP = $23,795 vs. TL = $31,470; P < 0.001). There was a significantly higher rate of major amputation (RP = 1.3% vs. TL = 6.6%; P < 0.001) and inpatient mortality (RP = 0.9% vs. TL = 1.9%; P < 0.001) after LER for TL. On multivariable analysis, TL was independently associated with increased major amputation (odds ratio [OR] 4.93, 95% confidence interval [CI] 4.18-5.81) and increased mortality (OR 1.42, 95% CI 1.16-1.74) compared to RP.
There is significant discrepancy in outcomes of LER for TL and RP. TL is independently associated with major amputation and inpatient mortality. Outcomes of LER for TL and RP should be reported separately for better benchmarking.
慢性肢体威胁性缺血（CLTI）表现为静息痛（RP）和组织丧失（TL）。下肢血运重建（LER）治疗 CLTI 的结果传统上被视为单一实体，并与跛行进行比较。我们假设与 RP 患者相比，出现 TL 的患者在 LER 后短期结果更差。
回顾了 2009 年至 2013 年的全国住院患者样本。确定了所有接受 TL 和 RP 进行 LER 的患者。记录患者特征、Charlson 合并症指数（CCI）、住院时间、住院内主要截肢率以及 LER 后的死亡率。进行多变量回归分析以确定两组之间住院内死亡率和主要截肢的预测因素。
共有 218628 例患者接受 LER（RP=76108，TL=142519）。TL 患者更有可能接受血管内 LER（RP=31.3% vs. TL=48.7%；P<0.001）。TL 患者的合并症更高，CCI≥3 的可能性增加（RP=22.9% vs. TL=40.3%；P<0.001）。TL 组的平均费用明显较高（RP=23795 美元 vs. TL=31470 美元；P<0.001）。TL 患者 LER 后的主要截肢率（RP=1.3% vs. TL=6.6%；P<0.001）和住院内死亡率（RP=0.9% vs. TL=1.9%；P<0.001）明显更高。多变量分析显示，与 RP 相比，TL 独立与更高的主要截肢（比值比[OR]4.93，95%置信区间[CI]4.18-5.81）和更高的死亡率（OR 1.42，95%CI 1.16-1.74）相关。
TL 和 RP 的 LER 结果存在显著差异。TL 与主要截肢和住院内死亡率独立相关。应单独报告 TL 和 RP 的 LER 结果，以便更好地进行基准测试。
