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Morbidity and mortality after emergency lower extremity embolectomy
Sergio Casillas-Berumen1, Lili Sadri1, Alik Farber1
1Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass.
Journal of Vascular Surgery
|February 27, 2017
Summary
Emergency lower extremity embolectomy carries significant risks, with a 13.9% 30-day mortality rate. A new model helps predict mortality based on patient factors, aiding in informed consent and care planning.
Area of Science:
- Vascular Surgery
- Outcomes Research
- Surgical Risk Prediction
Background:
- Emergency lower extremity embolectomy is a common procedure with poorly defined outcomes.
- Understanding perioperative morbidity is crucial for patient management.
Purpose of the Study:
- Define perioperative morbidity associated with emergency lower extremity embolectomy.
- Develop a risk prediction model for perioperative mortality.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement database.
- Included patients undergoing emergency unilateral lower extremity embolectomy, excluding specific criteria.
- Performed multivariate analysis to identify mortality predictors and develop a risk model.
Main Results:
- 1749 patients were analyzed; 30-day postoperative mortality was 13.9%.
- Common complications included pulmonary (16.0%) and wound issues (8.2%); 25.7% returned to the OR.
- A validated risk model identified age >70, male gender, functional dependence, and comorbidities as predictors of mortality.
Conclusions:
- Emergency lower extremity embolectomy is associated with high morbidity, mortality, and resource use.
- The developed risk model can aid in patient risk stratification.
- Improved risk assessment supports informed consent and goal-of-care discussions.
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