ObjectiveThe purpose of this study is to identify variables which places patients at higher risk for mortality following emergent infra-inguinal bypass. Further, this study will create a risk score for mortality following emergent infra-inguinal bypass to help tailor postoperative and long-term patient management. MethodsIn the Vascular Quality Initiative, we identified 2126 patients who underwent emergent infra-inguinal artery bypass. Two primary outcomes were investigated : 30 day mortality following emergent infra-inguinal bypass; and, 1 year mortality following emergent infra-inguinal bypass. The first step in analysis was univariable analysis for each outcome with Chi-squared analysis for categorical variables and student t-test for comparison of means of ordinal variables. Next, binary logistic regression analysis was performed for each outcome utilizing variables which achieved a univariable P value < .10. Factors with a multivariable P-value < .05 were included in the risk score and points were weighted and assigned based on the respective regression beta-coefficient in the multivariable regression. ResultsVariables with a significant multivariable association (P<.05) with one year mortality were : increasing age; BMI less than 20 kg/m2; CAD; active HD at time of presentation; anemia at admission; prosthetic conduit for emergent bypass; postoperative myocardial infarction (MI); postoperative acute renal insufficiency; perioperative stroke; baseline non-ambulatory status; new onset HD requirement perioperatively; need for bypass revision or thrombectomy during index admission; lack of statin prescription at discharge; lack of antiplatelet medication at discharge; and, lack of anticoagulation at time of hospital discharge. Pertinent negatives included all socio-demographic variables including rural living status, insurance status, and area deprivation index home area. The risk score achieved an area under the curve of .820 and regression analysis of the risk score achieved an overall accuracy of 87.9% with 97.7% accuracy in predicting survival indicating the model performs better in determining which patients will survive rather than precisely determining one year mortality. ConclusionsDischarge medications are the primary modifiable variable impacting survival after emergent infra-inguinal bypass surgery. In the absence of contra indication, all these patients should be discharged on antiplatelet, statin and anticoagulant medications after emergent infra-inguinal bypass as they significantly enhance survival. Social determinants of health do not impact survival amongst patients treated with emergent infra-inguinal bypass at VQI centers. A risk score for mortality at one year after emergent infra-inguinal bypass has been created that has excellent accuracy.