Independence and mobility after infrainguinal lower limb bypass surgery for critical limb ischemia

• Published in: Journal of vascular surgery Vol. 59; no. 4; pp. 983 - 987.e2
• Main Authors: Ambler, Graeme K., Dapaah, Andrew, Al Zuhir, Naail, Hayes, Paul D., Gohel, Manjit S., Boyle, Jonathan R., Varty, Kevin, Coughlin, Patrick A.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.04.2014
• Subjects: Aged; Aged, 80 and over; Amputation; Critical Illness; Dependent Ambulation; England; Female; Humans; Ischemia - diagnosis; Ischemia - mortality; Ischemia - physiopathology; Ischemia - therapy; Length of Stay; Limb Salvage; Lower Extremity - blood supply; Male; Middle Aged; Mobility Limitation; Patient Selection; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - pathology; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - therapy; Reoperation; Retrospective Studies; Risk Factors; Surgery; Time Factors; Treatment Outcome; Vascular Grafting - adverse effects; Vascular Grafting - mortality; Vascular Patency; England
• ISSN: 0741-5214; 1097-6809; 1097-6809
• DOI: 10.1016/j.jvs.2013.10.077

Critical limb ischemia (CLI) is a common condition associated with high levels of morbidity and mortality. Most work to date has focused on surgeon-oriented outcomes such as patency, but there is increasing interest in patient-oriented outcomes such as mobility and independence. This study was conducted to determine the effect of infrainguinal lower limb bypass surgery (LLBS) on postoperative mobility in a United Kingdom tertiary vascular surgery unit and to investigate causes and consequences of poor postoperative mobility. We collected data on all patients undergoing LLBS for CLI at our institution during a 3-year period and analyzed potential factors that correlated with poor postoperative mobility. During the study period, 93 index LLBS procedures were performed for patients with CLI. Median length of stay was 11 days (interquartile range, 11 days). The 12-month rates of graft patency, major amputation, and mortality were 75%, 9%, and 6%, respectively. Rates of dependence increased fourfold during the first postoperative year, from 5% preoperatively to 21% at 12 months. Predictors of poor postoperative mobility were female sex (P = .04) and poor postoperative mobility (P < .001), initially and at the 12-month follow-up. Patients with poor postoperative mobility had significantly prolonged hospital length of stay (15 vs 8 days; P < .001). Patients undergoing LLBS for CLI suffer significantly impaired postoperative mobility, and this is associated with prolonged hospital stay, irrespective of successful revascularization. Further work is needed to better predict patients who will benefit from revascularization and in whom a nonoperative strategy is optimal.