Department of Surgery, 12350University of Virginia, Charlottesville, VA, USA.
Division of Vascular and Endovascular Surgery, 12350University of Virginia, Charlottesville, VA, USA.
Angiology. 2021 Feb;72(2):159-165. doi: 10.1177/0003319720958554. Epub 2020 Sep 18.
The objective of this study is to describe utilization of revascularization and tissue resection in patients with chronic limb-threatening ischemia (CLTI) and determine whether the timing of resection impacts outcomes. Revascularizations for CLTI were queried (ACS-NSQIP 2011-2015). Outcomes included 30-day major adverse limb events (MALE), major adverse cardiac events (MACE), length of stay (LOS), operative time, 30-day readmissions, and wound infections. Groups included revascularization alone, revascularization/tissue resection during the same procedure (concurrent), or revascularization/delayed tissue resection (delayed). Resections were debridement or transmetatarsal amputations. Multivariate logistic regression determined risk-adjusted effects of tissue resection on outcomes. There was no difference in overall 30-day MACE or MALE between groups ( = .70 and = .35, respectively). Length of stay (6.1 days revascularization alone vs 7.8 days concurrent vs 8.7 days delayed, < .0001) was longer in patients who underwent any tissue resection. Highest 30-day readmission and operative time was the concurrent group ( = .02 and < .0001, respectively). Wound infection was highest in the delayed group (1.4% revascularization alone vs 1.3% concurrent vs 6.2% delayed, < .0001). After risk adjustment, timing of resection did not impact LOS for concurrent and delayed groups compared to revascularization alone (both < .0001). Debridement and minor amputations can be done concurrently in patients undergoing revascularization for CLTI.
本研究旨在描述慢性肢体威胁性缺血（CLTI）患者的血运重建和组织切除的利用情况，并确定切除的时机是否会影响结果。检索了 CLTI 的血运重建（ACS-NSQIP 2011-2015）。结果包括 30 天主要不良肢体事件（MALE）、主要不良心脏事件（MACE）、住院时间（LOS）、手术时间、30 天再入院和伤口感染。组包括单独血运重建、同一手术过程中的血运重建/组织切除（同期）或血运重建/延迟组织切除（延迟）。切除包括清创术或经跖骨截肢术。多变量逻辑回归确定了组织切除对结果的风险调整影响。各组之间 30 天总 MACE 或 MALE 无差异（分别为 =.70 和 =.35）。接受任何组织切除的患者的住院时间（单独血运重建为 6.1 天，同期为 7.8 天，延迟为 8.7 天， <.0001）更长。30 天再入院率和手术时间最高的是同期组（分别为 =.02 和 <.0001）。延迟组的伤口感染率最高（单独血运重建为 1.4%，同期为 1.3%，延迟为 6.2%， <.0001）。风险调整后，与单独血运重建相比，同期和延迟组的切除时机并不影响 LOS（均 <.0001）。在接受 CLTI 血运重建的患者中，可以同期进行清创术和小截肢术。
