Department of Vascular Surgery, Jefferson Abington Health, Abington, PA.
Department of Vascular Surgery, Jefferson Abington Health, Abington, PA.
J Vasc Surg. 2023 Jul;78(1):217-222. doi: 10.1016/j.jvs.2023.02.022. Epub 2023 Mar 11.
Peripheral artery disease is a worldwide epidemic that affects millions of patients, especially the elderly. It has a prevalence of 20% in individuals >80 years old. Although peripheral artery disease affects >20% of octogenarians, information about limb salvage rates in this patient population is limited. Therefore, this study aims to understand the impact of bypass surgery on limb salvage in patients aged >80 years with critical limb ischemia.
We conducted a retrospective analysis by querying the electronic medical records at a single institution from 2016 through 2022 to identify the population of interest and analyzed their outcomes after lower extremity bypass. The primary outcomes were limb salvage and primary patency, with hospital length of stay and 1-year mortality as secondary outcomes.
We identified 137 patients who met the inclusion criteria. The lower extremity bypass population was divided into two cohorts: <80 years old (n = 111) with a mean age of 66 or ≥80 years old (n = 26) with a mean age of 84 years. The gender distribution was similar (P = .163). No significant difference was found in the two cohorts when it came to coronary artery disease, chronic kidney disease, or diabetes mellitus. However, when current and former smokers were grouped together, they were significantly more common in the younger cohort when compared with nonsmokers (P = .028). The primary end point of limb salvage was not significantly different between the two cohorts. Hospital length of stay was not significantly different between the two cohorts with 4.13 days vs 4.17 days in the younger vs octogenarian cohorts, respectively (P = .95). The 30-day all-cause readmissions were also not found to be significantly different between the two groups. The primary patency at 1 year was 75% and 77% (P = .16) for the <80-year-old and ≥80-year-old cohorts, respectively. Mortality was low in both cohorts, with two and three for the younger and octogenarian populations, respectively; thus, no analysis was performed.
Our study shows that octogenarians who undergo the same preoperative risk assessment as younger populations have similar outcomes when it comes to primary patency, hospital length of stay, and limb salvage when comorbidities were considered. Further studies need to be done to determine the statistical impact on mortality in this population with a larger cohort.
外周动脉疾病是一种全球性的流行病，影响着数以百万计的患者，尤其是老年人。在 80 岁以上的人群中，其患病率为 20%。尽管外周动脉疾病影响着 20%以上的 80 岁以上人群，但关于这一患者群体保肢率的信息却很有限。因此，本研究旨在了解高龄（>80 岁）伴有临界肢体缺血的患者行旁路手术对保肢的影响。
我们通过查询单家机构 2016 年至 2022 年的电子病历进行了回顾性分析，以确定目标人群，并分析其下肢旁路手术后的结局。主要结局是保肢和原发性通畅，次要结局为住院时间和 1 年死亡率。
我们共确定了 137 名符合纳入标准的患者。下肢旁路人群分为两组：<80 岁（n=111）和≥80 岁（n=26），平均年龄分别为 66 岁和 84 岁。两组的性别分布相似（P=0.163）。两组在冠状动脉疾病、慢性肾脏病或糖尿病方面无显著差异。然而，当将当前吸烟者和曾经吸烟者归为一组时，与不吸烟者相比，年轻组中吸烟者明显更多（P=0.028）。两组的主要终点保肢率无显著差异。两组的住院时间也无显著差异，年轻组和 80 岁以上组分别为 4.13 天和 4.17 天（P=0.95）。两组 30 天内全因再入院率也无显著差异。两组 1 年原发性通畅率分别为 75%和 77%（P=0.16），分别为 <80 岁组和≥80 岁组。两组死亡率均较低，年轻组和 80 岁以上组各有 2 例和 3 例，因此未进行分析。
我们的研究表明，在考虑合并症的情况下，接受与年轻人群相同术前风险评估的 80 岁以上人群在原发性通畅、住院时间和保肢方面的结果相似。需要进一步的研究来确定该人群的死亡率在更大的队列中具有统计学意义。
