Birmpili Panagiota, Li Qiuju, Johal Amundeep S, Atkins Eleanor, Waton Sam, Pherwani Arun D, Williams Robin, Chetter Ian, Boyle Jonathan R, Cromwell David A
Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Hull York Medical School, University of Hull, Hull, UK.
Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Eur J Vasc Endovasc Surg. 2025 Apr;69(4):640-648. doi: 10.1016/j.ejvs.2024.12.038. Epub 2024 Dec 24.
Major amputation and death are significant outcomes after lower limb revascularisation for chronic limb threatening ischaemia (CLTI), but there is limited evidence on their association with the timing of revascularisation. The aim of this study was to examine the relationship between time from non-elective admission to revascularisation and one year outcomes for patients with CLTI.
This was an observational, population based cohort study of patients aged ≥ 50 years with CLTI admitted non-electively for infrainguinal revascularisation procedures in English National Health Service hospitals from January 2017 to December 2019 recorded in the Hospital Episode Statistics database. Outcomes were death and ipsilateral major amputation rate at one year. Logistic regression models were fitted to explore the relationship between time to revascularisation and death, adjusted for patient and admission factors. For major amputation, multinomial logistic regression models were used to account for the competing risk of death.
A total of 10 183 patients (median age 75 years) were included in the analysis, of which 67.1% (n = 6 831) were male and 57.6% had diabetes. In patients with tissue loss, the unadjusted one year mortality rate was 30.0% (95% confidence interval [CI] 28.9 - 31.0%), and for every one day increase in time from admission to revascularisation, the adjusted odds of one year death increased by 3% (odds ratio 1.03, 95% CI 1.02 - 1.04). In the absence of tissue loss, the unadjusted one year mortality rate was 19.9% (95% CI 18.4 - 21.4%) and there was no evidence of an association with time to revascularisation. There was also no statistically significant association between the time to revascularisation and risk of ipsilateral major amputation at one year irrespective of tissue loss.
Patients undergoing infrainguinal revascularisation during non-elective admissions for CLTI have high one year major amputation and mortality rates. Longer time from admission to revascularisation was independently associated with a higher mortality rate in patients with tissue loss, but not in those without.
对于慢性肢体威胁性缺血（CLTI）患者，大截肢和死亡是下肢血运重建术后的重要结局，但关于它们与血运重建时机的关联证据有限。本研究旨在探讨CLTI患者从非选择性入院到血运重建的时间与一年结局之间的关系。
这是一项基于人群的观察性队列研究，研究对象为2017年1月至2019年12月在英国国家医疗服务体系医院因CLTI非选择性入院接受腹股沟下血运重建手术的≥50岁患者，数据记录于医院事件统计数据库。结局指标为一年时的死亡和同侧大截肢率。采用逻辑回归模型探索血运重建时间与死亡之间的关系，并对患者和入院因素进行校正。对于大截肢，使用多项逻辑回归模型来考虑死亡的竞争风险。
共有10183例患者（中位年龄75岁）纳入分析，其中67.1%（n = 6831）为男性，57.6%患有糖尿病。在有组织缺损的患者中，未经校正的一年死亡率为30.0%（95%置信区间[CI] 28.9 - 31.0%），从入院到血运重建的时间每增加一天，校正后的一年死亡几率增加3%（比值比1.03，95% CI 1.02 - 1.04）。在无组织缺损的患者中，未经校正的一年死亡率为19.9%（95% CI 18.4 - 21.4%），且没有证据表明与血运重建时间有关联。无论有无组织缺损，血运重建时间与一年时同侧大截肢风险之间也无统计学显著关联。
因CLTI非选择性入院接受腹股沟下血运重建的患者一年时大截肢和死亡率较高。从入院到血运重建时间较长与有组织缺损患者的较高死亡率独立相关，但与无组织缺损患者无关。
