Trends and outcomes after surgical lower limb revascularization in England
Open Access
- 26 May 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Surgery
- Vol. 98 (10), 1373-1382
- https://doi.org/10.1002/bjs.7547
Abstract
Background The aim was to analyse contemporary data on the number of surgical revascularization procedures performed each year in England, and their outcome. Methods Hospital Episode Statistics and Office for National Statistics data were used to quantify numbers and identify factors associated with outcome after all femoropopliteal and femorodistal bypass procedures performed between 2002 and 2006. Outcome measures were repeat bypass, major amputation, death and a composite measure. Single-level multivariable logistic regression modelling was used to quantify the effect of these variables on outcome. Results A total of 21 675 femoropopliteal and 3458 femorodistal bypass procedures were performed. Mean in-hospital mortality rates were 6·7 and 8·0 per cent respectively. One-year survival rates were 82·8 and 79·1 per cent; both increased over the study interval. The mean 1-year major amputation rate after femoropopliteal bypass was 10·4 per cent, which decreased significantly over the 5 years (P < 0·001); after distal bypass the rate of 20·8 per cent remained unchanged (P = 0·456). Diabetes mellitus and chronic kidney disease were significant predictors of adverse outcome for both procedures: odds ratio (OR) at 1 year 1·56 (95 per cent confidence interval 1·46 to 1·67; P < 0·001) and 2·15 (1·88 to 2·45; P < 0·001) respectively for femoropopliteal bypass. Previous femoral angioplasty was associated with an increased rate of major amputation 1 year after proximal bypass (OR 1·18, 1·05 to 1·33; P = 0·004). Conclusion Although all mortality rates are improving, the major amputation rate remains high after femorodistal bypass. Adverse events occurred after 37·6 per cent of femoropopliteal and 49·7 per cent of femorodistal bypasses; diabetes and chronic renal failure were the main predictors of poor outcome.This publication has 29 references indexed in Scilit:
- Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategyJournal of Vascular Surgery, 2010
- Epidemiological study of lower limb amputation in England between 2003 and 2008British Journal of Surgery, 2010
- Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson ScoreBritish Journal of Surgery, 2010
- Global estimates of the prevalence of diabetes for 2010 and 2030Diabetes Research and Clinical Practice, 2010
- Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)Journal of Vascular Surgery, 2007
- Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trialThe Lancet, 2005
- Risk factors, medical therapies and perioperative events in limb salvage surgery: Observations from the PREVENT III multicenter trialJournal of Vascular Surgery, 2005
- Global Prevalence of DiabetesDiabetes Care, 2004
- Patients undergoing infrainguinal bypass to treat atherosclerotic vascular disease are underprescribed cardioprotective medications: effect on graft patency, limb salvage, and mortalityJournal of Vascular Surgery, 2004
- Outcome events in patients with claudication: A 15-year study in 2777 patientsJournal of Vascular Surgery, 2001