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Barthel Index and Outcome of Open Bypass for Critical Limb Ischemia
Shinsuke Mii1, Atsushi Guntani1, Eisuke Kawakubo1
1Department of Vascular Surgery, Saiseikai Yahata General Hospital.
Insights
Daily activity, measured by the Barthel index (BI), impacts critical limb ischemia (CLI) outcomes. Patient function at discharge, not admission, predicts long-term survival and amputation-free survival after bypass surgery.
Area of Science:
- Vascular Surgery
- Patient Outcomes Research
- Geriatric Medicine
Background:
- Critical limb ischemia (CLI) management requires consideration of daily activity levels.
- Activities of daily living (ADL) are hypothesized to correlate closely with patient prognosis in CLI.
- Open bypass surgery is a common treatment for CLI.
Purpose of the Study:
- To investigate the association between ADL and outcomes following open bypass for CLI.
- To determine if pre-operative ADL status predicts outcomes in CLI patients undergoing bypass.
- To evaluate the prognostic significance of ADL at different time points.
Main Methods:
- Retrospective review of 226 patients undergoing infrainguinal bypass for CLI (2005-2015).
- Patients categorized by Barthel index (BI) at admission (pre-BI ≥60 vs. <60).
- Comparison of early adverse events, 3-year overall survival, and amputation-free survival between groups.
Main Results:
- Patients with pre-BI <60 experienced more frequent early adverse events.
- Lower pre-BI (<60) was associated with worse long-term outcomes (survival and amputation-free survival).
- Multivariable analysis identified hypoalbuminemia, end-stage renal disease, and BI at discharge <60 as significant predictors of 3-year outcomes, but not pre-BI <60.
Conclusions:
- Barthel index (BI) at discharge is a significant determinant of long-term outcomes in CLI patients post-bypass.
- Pre-operative ADL status (pre-BI) is not a significant predictor of long-term outcomes.
- Focusing on functional status at discharge is crucial for predicting CLI patient prognosis after open bypass.
Background:
Daily activity should be an important factor to consider when deciding on a treatment strategy for critical limb ischemia (CLI), and we hypothesized that there was a close relationship between activities of daily living (ADL) and prognosis. The aim of this study was to investigate the association between ADL and outcomes of open bypass for CLI.
Methods And Results:
A total of 226 patients undergoing infrainguinal bypass for CLI between January 2005 and December 2015 were reviewed. They were divided into 2 groups based on Barthel index (BI) at admission (pre-BI; ≥60 and <60) and compared with respect to the incidence of early adverse events and 3-year overall survival and amputation-free survival. Adverse events were more frequently observed in patients with pre-BI <60. Patients with pre-BI <60 had worse long-term outcomes. On multivariable analysis, hypoalbuminemia, end-stage renal disease, and BI at discharge <60 were significant predictors of 3-year outcomes, whereas pre-BI <60 was not a significant predictor of either outcome.
Conclusions:
It is not BI at admission, but BI at discharge that determines long-term outcome.
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