Related Experiment Video
Updated: May 22, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Development and validation of a risk calculator for prediction of mortality after infrainguinal bypass surgery
Prateek K Gupta1, Bala Ramanan, Thomas G Lynch
1Department of Surgery, Creighton University, Omaha, Neb., USA.
Insights
A new risk calculator predicts 30-day mortality after infrainguinal bypass grafting (BPG). This tool aids surgical decisions and patient consent for elective BPG procedures.
Area of Science:
- Vascular Surgery
- Health Services Research
- Medical Informatics
Background:
- Infrainguinal bypass grafting (BPG) for peripheral arterial disease has higher perioperative risks than endovascular procedures.
- Risk assessment tools for BPG are lacking, complicating treatment choices.
- Accurate risk prediction is crucial for patient management and decision-making.
Purpose of the Study:
- To develop and validate a risk calculator for estimating 30-day perioperative mortality after elective infrainguinal bypass grafting (BPG).
Main Methods:
- Analysis of 9556 patients undergoing elective BPG from 2007-2009 National Surgical Quality Improvement Program data.
- Multivariable logistic regression identified predictors of 30-day mortality.
- Internal validation using bootstrapping and development of an interactive risk calculator.
Main Results:
- The 30-day mortality rate was 1.8%.
- Seven preoperative predictors identified: age, SIRS, corticosteroid use, COPD, dependent functional status, dialysis dependence, and rest pain.
- The validated model showed excellent discrimination (C-statistic 0.81) and calibration.
Conclusions:
- A validated risk calculator accurately predicts 30-day mortality post-elective BPG.
- The tool can assist in surgical decision-making, patient consent, and preoperative optimization.
- Implementation is expected to contribute to perioperative risk reduction.
Objective:
For peripheral arterial disease, infrainguinal bypass grafting (BPG) carries a higher perioperative risk compared with peripheral endovascular procedures. The choice between the open and endovascular therapies is to an extent dependent on the expected periprocedural risk associated with each. Tools for estimating the periprocedural risk in patients undergoing BPG have not been reported in the literature. The objective of this study was to develop and validate a calculator to estimate the risk of perioperative mortality ≤30 days of elective BPG.
Methods:
We identified 9556 patients (63.9% men) who underwent elective BPG from the 2007 to 2009 National Surgical Quality Improvement Program data sets. Multivariable logistic regression analysis was performed to identify risk factors associated with 30-day perioperative mortality. Bootstrapping was used for internal validation. The risk factors were subsequently used to develop a risk calculator.
Results:
Patients had a median age of 68 years. The 30-day mortality rate was 1.8% (n = 170). Multivariable logistic regression analysis identified seven preoperative predictors of 30-day mortality: increasing age, systemic inflammatory response syndrome, chronic corticosteroid use, chronic obstructive pulmonary disease, dependent functional status, dialysis dependence, and lower extremity rest pain. Bootstrapping was used for internal validation. The model demonstrated excellent discrimination (C statistic, 0.81; bias-corrected C statistic, 0.81) and calibration. The validated risk model was used to develop an interactive risk calculator using the logistic regression equation.
Conclusions:
The validated risk calculator has excellent predictive ability for 30-day mortality in a patient after an elective BPG. It is anticipated to aid in surgical decision making, informed patient consent, preoperative optimization, and consequently, risk reduction.
