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Independence and mobility after infrainguinal lower limb bypass surgery for critical limb ischemia
Graeme K Ambler1, Andrew Dapaah1, Naail Al Zuhir1
1Department of Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Insights
Infrainguinal lower limb bypass surgery for critical limb ischemia significantly impairs patient mobility post-operation. This reduced mobility is linked to longer hospital stays, regardless of successful revascularization outcomes.
Area of Science:
- Vascular Surgery
- Patient Outcomes Research
- Rehabilitation Medicine
Background:
- Critical limb ischemia (CLI) presents significant morbidity and mortality risks.
- Focus is shifting from surgeon-centric (e.g., patency) to patient-centric outcomes (e.g., mobility).
Purpose of the Study:
- To evaluate the impact of infrainguinal lower limb bypass surgery (LLBS) on postoperative mobility.
- To identify factors contributing to and consequences of poor mobility after LLBS.
Main Methods:
- Retrospective analysis of patients undergoing LLBS for CLI over a 3-year period.
- Investigation of variables correlating with diminished postoperative mobility.
Main Results:
- 93 LLBS procedures were performed; 12-month outcomes included 75% graft patency, 9% amputation, 6% mortality.
- Patient dependence increased from 5% preoperatively to 21% at 12 months post-LLBS.
- Female sex and initial poor mobility predicted worse outcomes; poor mobility correlated with prolonged hospital stay (15 vs 8 days).
Conclusions:
- LLBS for CLI leads to substantial postoperative mobility impairment.
- Impaired mobility is associated with extended hospital stays, independent of revascularization success.
- Further research is needed to identify patients who will benefit most from revascularization versus nonoperative strategies.
Background:
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.
Objective:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
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