Outcomes for popliteal artery injury repair after discharge: A large-scale population-based analysis
| Autor: | Michael J. Sise, Vishal Bansal, C. Beth Sise, Richard Y. Calvo, Lyndsey E. Wessels, William J. Butler, Jason M. Bowie |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Population Population based Critical Care and Intensive Care Medicine Amputation Surgical 03 medical and health sciences 0302 clinical medicine Risk Factors medicine.artery medicine Humans Popliteal Artery Prospective Studies education Retrospective Studies education.field_of_study business.industry Endovascular Procedures 030208 emergency & critical care medicine Middle Aged Vascular System Injuries Injury repair After discharge Popliteal artery Fasciotomy Surgery Logistic Models Open repair Female business Vascular Surgical Procedures Leg Injuries |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 86:173-180 |
| ISSN: | 2163-0763 2163-0755 |
| DOI: | 10.1097/ta.0000000000002118 |
| Popis: | Although short-term outcomes for popliteal artery injury after endovascular versus open repair appear similar, studies on outcomes after discharge are limited. We evaluated popliteal artery injury repair in a population-based data set. We hypothesized that postdischarge outcomes for open repair are superior to endovascular repair.Patients with popliteal artery injury were identified in the California Office of Statewide Health Planning and Development 2007-2014 discharge database. Popliteal artery injury and other lower-extremity injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Procedure codes were evaluated to identify open repair, endovascular repair, fasciotomy, and amputation. Primary outcomes were mortality or amputation. The association between repair method and each outcome was evaluated with logistic regression. Postdischarge amputation and all-cause mortality were evaluated using survival analysis.Among 769 patients with popliteal artery injury, open repair occurred in 456 (59.3%), endovascular repair in 37 (4.3%), combined endovascular and open in 18 (2.3%), and nonoperative management in 258 (33.6%). Fasciotomy was performed more frequently in open than endovascular repair (p = 0.001) during index admission. Amputation rate was also increased in open repair, but this was not significant (p = 0.196). Arterial thromboembolus during index admission was more likely after endovascular or combined endovascular and open compared with open (24.3%, 55.6%, 16.7%, respectively, p0.001). Patients requiring both endovascular and open were more likely to undergo amputation postdischarge (hazard ratio, 4.11; 95% confidence interval, 1.16-14.53). Patients undergoing endovascular repair were more likely to die postdischarge (hazard ratio, 4.43; 95% confidence interval, 1.06-18.56) compared with patients who had open repair (median, 98.5 days postdischarge).In a large cohort with popliteal artery injury, open repair was associated with lower rates of index admission arterial thromboembolus as well as postdischarge amputation and all-cause mortality. We recommend conducting a prospective multicenter study to examine the appropriate use of endovascular repair for this injury.Therapeutic, level IV. |
| Databáze: | OpenAIRE |
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