Discrepancy in Outcomes after Revascularization for Chronic Limb-Threatening Ischemia Warrants Separate Reporting of Rest Pain and Tissue Loss
Discrepancy in Outcomes after Revascularization for Chronic Limb-Threatening Ischemia Warrants Separate Reporting of Rest Pain and Tissue Loss
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DOI：
10.1016/j.avsg.2020.06.057
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发表时间：
2021-01-01
影响因子：
1.5
通讯作者：
Chaar, Cassius Iyad Ochoa
中科院分区：
文献类型：
--
作者：
Brahmandam, Anand;Gholitabar, Navid;Chaar, Cassius Iyad Ochoa
背景：慢性肢体威胁性缺血（CLTI）表现为静息痛（RP）和组织缺损（TL）。CLTI的下肢血运重建（LER）的结局传统上被作为一个单一的实体进行评价，并与跛行进行比较。我们假设，TL患者LER后有更差的短期结果，与RP患者相比。方法：2009年至2013年之间的国家住院患者样本进行了审查。确定了所有接受LER治疗TL和RP的患者。记录患者特征、Charlson合并症指数（CCI）、住院时间、住院患者大截肢率和LER后死亡率。进行多变量回归分析，以确定两组之间的住院死亡率和大截肢的预测因素。结果：共有218，628例患者接受LER（RP = 76，108，TL = 142，519）。TL患者更可能接受血管内LER（RP = 31.3% vs. TL = 48.7%; P < 0.001）。TL患者有更高的合并症，如CCI ≥ 3的可能性增加所示（RP = 22.9% vs. TL = 40.3%; P < 0.001）。TL组的平均成本显著更高（RP = 23，795美元vs. TL = 31，470美元; P < 0.001）。LER治疗TL后，大截肢率（RP = 1.3% vs. TL = 6.6%; P < 0.001）和住院死亡率（RP = 0.9% vs. TL = 1.9%; P < 0.001）显著较高。在多变量分析中，TL与RP相比，与大截肢增加（比值比[OR] 4.93，95%置信区间[CI] 4.18-5.81）和死亡率增加（OR 1.42，95% CI 1.16-1.74）独立相关。结论：TL和RP的LER结局存在显著差异。TL与大截肢和住院死亡率独立相关。TL和RP的LER结果应单独报告，以便更好地进行基准测试。
Background: Chronic limb-threatening ischemia (CLTI) manifests as rest pain (RP) and tissue loss (TL). Outcomes of lower extremity revascularization (LER) for CLTI have traditionally been evaluated as a single entity and compared with claudication. We hypothesize that patients presenting with TL have worse short-term outcomes after LER, compared to patients with RP.Methods: The National Inpatient Sample was reviewed between 2009 and 2013. All patients undergoing LER for TL and RP were identified. Patient characteristics, Charlson Comorbidity Index (CCI), length of stay, rates of inpatient major amputation, and mortality after LER were noted. Multivariable regression analysis was performed to identify predictors of inpatient mortality and major amputation between the 2 groups.Results: A total of 218,628 patients underwent LER (RP = 76,108, TL = 142,519). Patients with TL were more likely to undergo endovascular LER (RP = 31.3% vs. TL = 48.7%; P < 0.001). Patients with TL had higher comorbidities as suggested by increased likelihood of having CCI >= 3 (RP = 22.9% vs. TL = 40.3%; P < 0.001). The mean costs were significantly higher in the TL group (RP = $23,795 vs. TL = $31,470; P < 0.001). There was a significantly higher rate of major amputation (RP = 1.3% vs. TL = 6.6%; P < 0.001) and inpatient mortality (RP = 0.9% vs. TL = 1.9%; P < 0.001) after LER for TL. On multivariable analysis, TL was independently associated with increased major amputation (odds ratio [OR] 4.93, 95% confidence interval [CI] 4.18-5.81) and increased mortality (OR 1.42, 95% CI 1.16-1.74) compared to RP.Conclusions: There is significant discrepancy in outcomes of LER for TL and RP. TL is independently associated with major amputation and inpatient mortality. Outcomes of LER for TL and RP should be reported separately for better benchmarking.