Morbidity and mortality after emergency lower extremity embolectomy

Autor: Denis Rybin, Mohammad H. Eslami, Alik Farber, Jeffrey J. Siracuse, Jeffrey A. Kalish, Sergio Casillas-Berumen, Gheorghe Doros, Lili Sadri
Rok vydání: 2017
Předmět:
Male
Time Factors
Databases
Factual
medicine.medical_treatment
Embolism
Embolectomy
030204 cardiovascular system & hematology
Angina
Postoperative Complications
0302 clinical medicine
Risk Factors
Odds Ratio
Hospital Mortality
030212 general & internal medicine
Myocardial infarction
Aged
80 and over
Middle Aged
Fasciotomy
Benchmarking
Treatment Outcome
Lower Extremity
Area Under Curve
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Reoperation
medicine.medical_specialty
Patient Readmission
Risk Assessment
Decision Support Techniques
03 medical and health sciences
Predictive Value of Tests
medicine
Humans
Aged
Retrospective Studies
business.industry
Retrospective cohort study
Critical limb ischemia
Perioperative
Odds ratio
Length of Stay
medicine.disease
United States
Surgery
ROC Curve
Heart failure
Multivariate Analysis
Emergencies
business
Zdroj: Journal of Vascular Surgery. 65:754-759
ISSN: 0741-5214
DOI: 10.1016/j.jvs.2016.08.116
Popis: Objective Emergency lower extremity embolectomy is a common vascular surgical procedure that has poorly defined outcomes. Our goal was to define the perioperative morbidity for emergency embolectomy and develop a risk prediction model for perioperative mortality. Methods The American College of Surgeons National Surgical Quality Improvement database was queried to identify patients undergoing emergency unilateral and lower extremity embolectomy. Patients with previous critical limb ischemia, bilateral embolectomy, nonemergency indication, and those undergoing concurrent bypass were excluded. Patient characteristics and postoperative morbidity and mortality were analyzed. Multivariate analysis for predictors of mortality was performed, and from this, a risk prediction model was developed to identify preoperative predictors of mortality. Results There were 1749 patients (47.9% male) who met the inclusion criteria. The average age was 68.2 ± 14.8 years. Iliofemoral-popliteal embolectomy was performed in 1231 patients (70.4%), popliteal-tibioperoneal embolectomy in 303 (17.3%), and at both levels in 215 (12.3%). Fasciotomies were performed concurrently with embolectomy in 308 patients (17.6%). The 30-day postoperative mortality was 13.9%. Postoperative complications included myocardial infarction or cardiac arrest (4.7%), pulmonary complications (16.0%), and wound complications (8.2%). The rate of return to the operating room ≤30 days was 25.7%. Hospital length of stay was 9.8 ± 11.5 days, and the 30-day readmission rate was 16.3%. A perioperative mortality risk prediction model based on factors identified in multivariate analysis included age >70 years, male gender, functional dependence, history of chronic obstructive pulmonary disease, congestive heart failure, recent myocardial infarction/angina, chronic renal insufficiency, and steroid use. The model showed good discrimination (C = 0.769; 95% confidence interval, 0733-0.806) and calibrated well. Conclusions Emergency lower extremity embolectomy has high morbidity, mortality, and resource utilization. These data provide a benchmark for this complex patient population and may assist in risk stratifying patients, allowing for improved informed consent and goals of care at the time of presentation.
Databáze: OpenAIRE
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