Hybrid surgery for bilateral lower extremity inflow revascularization.

Area of Science:

• Vascular Surgery
• Surgical Outcomes Research
• Health Services Research

Background:

• Aortobifemoral (ABF) bypass is standard for bilateral inflow revascularization, while axillobifemoral (AXBF) bypass is for high-risk cases.
• Hybrid (HYB) surgery, combining femorofemoral bypass with endovascular intervention, is an emerging alternative for similar goals.
• This study aimed to compare perioperative outcomes between HYB surgery and traditional bypass methods.

Purpose of the Study:

• To compare the perioperative outcomes of hybrid surgery with traditional aortobifemoral bypass for bilateral inflow revascularization.
• To evaluate the safety and efficacy of hybrid procedures versus established surgical techniques.
• To identify potential benefits of hybrid surgery in reducing complications and hospital stay.

Main Methods:

• Analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2012-2015).
• Inclusion of patients undergoing aortobifemoral bypass, axillobifemoral bypass, and hybrid surgery.
• Propensity-matched analysis comparing hybrid surgery with aortobifemoral bypass, utilizing statistical tests for risk factor and outcome evaluation.

Main Results:

• Hybrid surgery patients experienced significantly less pneumonia, unplanned intubation, cardiac arrest, and transfusion compared to ABF bypass.
• Hybrid surgery was associated with lower composite morbidity, mortality, and 30-day reoperation rates.
• Patients undergoing hybrid surgery had a shorter total hospital length of stay without differences in major amputation or readmission rates.

Conclusions:

• Aortobifemoral bypass remains a common procedure with good outcomes for bilateral lower extremity revascularization.
• Hybrid surgery offers improved perioperative and 30-day outcomes in selected patients compared to aortobifemoral bypass.
• Hybrid procedures represent a promising alternative, potentially enhancing patient recovery and reducing healthcare resource utilization.