The effect of ambulatory status on outcomes of percutaneous vascular interventions and lower extremity bypass for critical limb ischemia in the Vascular Quality Initiative

Abstract

ObjectiveAmbulatory status has been shown to be an important predictor of postoperative morbidity and mortality for a variety of surgical procedures. We sought to assess contemporary practice patterns in treating critical limb ischemia (CLI) and outcomes based on ambulatory status. MethodsThe Vascular Quality Initiative (2010-2015) was queried for patients undergoing percutaneous vascular interventions (PVIs) or lower extremity bypass (LEB) for CLI. Ambulatory status was classified as ambulatory, ambulatory with assistance, and nonambulatory (composite of wheelchair bound and bedridden). Perioperative and postoperative outcomes were recorded. Multivariable analyses were performed to identify the effect of ambulatory status. ResultsThere were 11,522 ambulatory (PVI, 63%; LEB, 37%), 4443 ambulatory with assistance (PVI, 67%; LEB, 33%), and 1732 nonambulatory (PVI, 77%; LEB, 23%) patients with CLI treated (P < .01 across ambulatory status groups). Perioperative mortality for PVI and LEB for ambulatory, ambulatory with assistance, and nonambulatory status was 1.5% and 1.7%, 3.0% and 3.1%, and 4.7% and 4.9%, respectively (P < .01 across ambulatory status groups). Worsening ambulatory status was associated with higher perioperative complications with PVI and LEB. Multivariable analysis showed that worsening ambulatory status predicted higher postprocedural mortality, amputation or death, and major adverse limb events or death. ConclusionsIn the Vascular Quality Initiative, as ambulatory status declines, perioperative morbidity and mortality increase. Impaired ambulatory patients are more likely to receive PVI than LEB for the treatment of CLI, although even among nonambulatory patients, there are still a significant number who receive LEB.