Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ.
Ann Vasc Surg. 2022 Jul;83:284-289. doi: 10.1016/j.avsg.2021.11.025. Epub 2021 Dec 22.
Tibial revascularization is often performed in the setting of critical limb ischemia and tissue loss requiring close patient monitoring in the early post-operative period for worsening gangrene and/or ischemia. Multiple studies have shown loss to follow-up is an independent risk factor for poor outcomes in several vascular procedures. Therefore, we evaluated the risk factors relating to loss to follow up against outcomes in patients undergoing tibial endovascular procedures with the hypothesis that poor post-operative visit compliance is associated with decreased amputation-free survival rates.
We performed a single-institution retrospective chart review of patients who underwent therapeutic endovascular tibial revascularization between 2014-2018. Patient follow-up and outcomes of death or major amputation (trans-tibial/trans-femoral) were followed up to 36-months post-operatively. Patients who had undergone previous infra-geniculate interventions or reached mortality/major amputation within 30-days post-operatively were excluded from analysis.
We identified 89 patients who met inclusion criteria. The overall rate of attendance at less than <1 month, 1-6 months, 6-15 months and 15-36 months post-operatively were 60%, 64%, 60 and 40% respectively. 16% of patients had complete loss to follow-up. Patients without tissue loss (≤ Rutherford 4) were less likely to attend early <1 month and 1-6 month follow-up intervals. Notably, absenteeism from the first immediate post-operative visit was a significant risk factor for further absenteeism at 1-6 months (51% vs. 26%; P = 0.01) and at greater than 6-month follow-up (48% vs. 31%; P = 0.05). Compared to the cohort of all patients, failure to follow-up within 1 month was associated with a decrease in attendance from 64% to 26% at 1-6 months and 63-31% at more than 6 months. Missing the first post-operative visit was also associated with decreased amputation-free survival (P = 0.04).
Absenteeism from the first post-operative visit is associated with worse amputation-free survival and a significant risk factor for further absenteeism from post-operative care. Given these results, ensuring close immediate post-operative follow up is essential to improving outcomes in patients undergoing tibial revascularization.
在临界肢体缺血和需要组织损失的情况下，通常进行胫骨血运重建，需要在术后早期密切监测患者，以防止坏疽和/或缺血恶化。多项研究表明，在多种血管手术中，失访是不良结局的独立危险因素。因此，我们评估了与胫骨腔内血管重建术后失访相关的风险因素，假设术后就诊依从性差与降低截肢率无关。
我们对 2014 年至 2018 年间接受治疗性腔内胫骨血运重建的患者进行了单中心回顾性图表审查。患者的随访和死亡或主要截肢（经胫骨/经股骨）的结果随访至术后 36 个月。已接受过下肢动脉旁路术或术后 30 天内发生死亡/主要截肢的患者被排除在分析之外。
我们确定了 89 名符合纳入标准的患者。术后 1 个月、1-6 个月、6-15 个月和 15-36 个月时就诊率分别为 60%、64%、60%和 40%。16%的患者完全失访。无组织损失（≤Rutherford 4）的患者不太可能在术后 1 个月和 1-6 个月的随访期间就诊。值得注意的是，第一次术后就诊缺勤是术后 1-6 个月（51%比 26%；P=0.01）和随访超过 6 个月（48%比 31%；P=0.05）缺勤的显著危险因素。与所有患者的队列相比，1 个月内失访与 1-6 个月时就诊率从 64%降至 26%和 63-31%以上的就诊率相关。错过第一次术后就诊也与无截肢生存率降低相关（P=0.04）。
第一次术后就诊缺勤与较差的无截肢生存率相关，是术后护理进一步缺勤的显著危险因素。鉴于这些结果，确保密切的术后早期随访对于改善胫骨血运重建患者的结局至关重要。
