BACKGROUND: Most patients with critical limb ischemia (CLI) exhibit severe comorbidities accompanied by frailty. This study assessed and risk-stratified mortality after infrainguinal bypass (IB) in CLI and investigated the effects of frailty.Methods and Results: The study retrospectively reviewed 107 consecutive CLI patients who had undergone de novo IB due to atherosclerotic disease. Data regarding patient age, comorbidities, laboratory data, and functional status were collected; functional status was evaluated using the Barthel index (BI) and nutritional status was evaluated using albumin concentrations and body mass index (BMI). Mean (±SD) BI and BMI were 75±16 and 22±4 kg/m2, respectively. BI (hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94-0.99, P=0.004), BMI (HR 0.85; 95% CI 0.75-0.95, P=0.003), atrial fibrillation (AF; HR 5.31; 95% CI 2.12-13.30, P<0.001), and ejection fraction (EF; HR 0.94; 95% CI 0.91-0.98, P=0.003) were independent predictors of mortality. Patients were divided into 2 groups based on BI (BI >75, n=71; and BI <70, n=36). Survival after IB was significantly lower for the lower BI group (P<0.001, log-rank test). After propensity score matching, post-IB survival remained significantly lower in the lower BI group (P=0.02). CONCLUSIONS: BI, BMI, AF, and EF were independently associated with all-cause mortality after IB for CLI. BI and BMI may be useful in identifying and optimizing treatment for high-risk frail patients.
BACKGROUND: Most patients with critical limb ischemia (CLI) exhibit severe comorbidities accompanied by frailty. This study assessed and risk-stratified mortality after infrainguinal bypass (IB) in CLI and investigated the effects of frailty.Methods and Results: The study retrospectively reviewed 107 consecutive CLI patients who had undergone de novo IB due to atherosclerotic disease. Data regarding patient age, comorbidities, laboratory data, and functional status were collected; functional status was evaluated using the Barthel index (BI) and nutritional status was evaluated using albumin concentrations and body mass index (BMI). Mean (±SD) BI and BMI were 75±16 and 22±4 kg/m2, respectively. BI (hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94-0.99, P=0.004), BMI (HR 0.85; 95% CI 0.75-0.95, P=0.003), atrial fibrillation (AF; HR 5.31; 95% CI 2.12-13.30, P<0.001), and ejection fraction (EF; HR 0.94; 95% CI 0.91-0.98, P=0.003) were independent predictors of mortality. Patients were divided into 2 groups based on BI (BI >75, n=71; and BI <70, n=36). Survival after IB was significantly lower for the lower BI group (P<0.001, log-rank test). After propensity score matching, post-IB survival remained significantly lower in the lower BI group (P=0.02). CONCLUSIONS:BI, BMI, AF, and EF were independently associated with all-cause mortality after IB for CLI. BI and BMI may be useful in identifying and optimizing treatment for high-risk frail patients.
Authors: Sarah J Aitken; Bernard Allard; Nishath Altaf; Noel Atkinson; Omar Aziz; Ruth Battersby; Ruth Benson; Jennifer L Chambers; Gabriella Charlton; Chloe Coleman; Joseph A Dawson; Anastasia Dean; Bedanta S Dhal; Robert Fitridge; John Gan; Joseph Hanna; Andrew T Hattam; Martin Hein; Kay Hon; Samantha Khoo; Joseph Kilby; Beatrice Kuang; Kai Wen Leong; Eunice Lim; Ju-Wei N Liu; David N McClure; Shreya Mehta; Jana-Lee Moss; Juanita Muller; Korana Musicki; Sandip Nandhra; Michael J Papanikolas; Fernando Picazo Pineda; Franklin Pond; Nandhini Ravintharan; Toby Richards; Hani Saeed; Christopher N Selvaraj; Gurkirat Singh; Yogeesan Sivakumaran; Bethany M Stavert; Elizabeth Suthers; Robert Tang; Vincent C Varley; Thodur M Vasudevan; Uyen G Vo; Timothy Wagner; Judy Wang; Jackie Wong Journal: ANZ J Surg Date: 2022-06-08 Impact factor: 2.025