An Analysis of Factors that Predict Outcomes Following Surgical Lower Limb Revascularisation

Abstract

Introduction: Endovascular revascularisation strategies are becoming increasingly prevalent for more complex supra- and infrainguinal atherosclerotic lesions. Given this, this study performs a contemporary analysis of factors that predict outcomes in patients undergoing surgical lower limb revascularisation. Methods: We analysed a consecutive series of patients having open surgical lower limb revascularisation over the course of 24 months. Patients were followed up for 24-36 months. Data was collated on demographics, comorbidity, and type of surgery. The primary outcome measure was one year mortality. Secondary outcomes were major in-hospital events, ICU admission, and surgical re-intervention. Multivariate analysis was performed to determine significance. Results: A total of 275 patients (208 men, median age 70 years) formed the cohort. The one year mortality rate was 7.27%. On multivariate analysis, pre-op diagnosis OR 0.346 (95% CI: 0.133-0.903, p = 0.030), haemoglobin OR 1.030 (95% CI: 1.004-1.056, p =0.025) and a diagnosis of diabetes mellitus OR 9.226 (1.805 - 12.172, p=0.008) were predictive of one year mortality. Major in-hospital events occurred in 16.2% of patients. Predictors were supra-inguinal surgery 0R: 3.461 (95% CI: 1.533-7.813), pre-operative diagnosis: OR: 1.533 (95% CI:1.251-2.473), pre-operative lower Hb levels OR: 0.973 (95% CI: 0.954-0.992), and a higher pre-operative potassium level OR: 3.041 (95% CI: 1.283-7.207, all p< 0.05). 1.8% of patients required admission to ICU post-surgery. Supra-inguinal surgery was a very strong predictive factor OR: 10.203 (95% CI: 1.008-23.323, p=0.049). 37.8 % of patients required surgical re-intervention after their initial surgery. Predictors were the Charlson Comorbidity Index (CCI) OR: 0.595 (95% CI: 0.382-0.927, p=0.022), modified CCI OR: 1.580 (95% CI: 1.074-2.324, p=0.020), and pre-operative diagnosis OR: 1.654 (95% CI: 1.212-2.256, p=0.002). Conclusion: This study reaffirms the predictive factor of some factors for poorer outcomes following lower limb surgical revascularisation. It provides further data on the significantly poor outcomes in patients with diabetes. The potential management of pre-operative anaemia requires further examination. Disclosure: Nothing to disclose