Thirty-Day Outcomes of Infrainguinal Bypass Surgery in Patients With Disseminated Cancer

Disseminated cancer can complicate the decision-making for major surgery, as patients can be poor surgical candidates and have potentially limited life expectancy. This study aimed to evaluate the 30-day postoperative outcomes of infrainguinal bypass in patients with disseminated cancer using a large-scale national database.

Adult patients with and without disseminated cancer who underwent infrainguinal bypass were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2023. A 1:5 propensity-score matching was used to balance the preoperative factors. Thirty-day postoperative outcomes were compared. A separate multivariable analysis was also conducted.

There were 25,200 patients who underwent infrainguinal bypass, where 120 (0.48%) patients had disseminated cancer, who were matched to 596 patients with no disseminated cancer. Patients with disseminated cancer had higher risks of mortality (13.33% vs. 6.21%, P = 0.01) and untreated loss of patency (5.83% vs. 1.34%, P = 0.01). Other 30-day outcomes, including major amputation (5.41% vs. 4.24%, P = 0.61), cardiac complications (4.17% vs. 5.54%, P = 0.66), stroke (0.83% vs. 0.84%, P = 1.00), pulmonary complications (2.50% vs. 6.71%, P = 0.09), and renal complications (0.83% vs. 2.35%, P = 0.49), were comparable between patients with and without disseminated cancer. Multivariable analysis confirmed higher mortality and untreated loss of patency among disseminated cancer patients, while deep vein thrombosis was also found to be higher in this group (4.17% vs. 0.96%, adjusted odds ratio 3.763, 95% confidence interval 1.507-9.399, P < 0.01).

Disseminated cancer patients demonstrated more than twice the 30-day mortality risk and over 4 times the risk of untreated loss of patency. As such, infrainguinal bypass should be considered a high-risk procedure for disseminated cancer patients, and the clinical decision for surgery should be made with caution. Deep vein thrombosis (DVT) was also found to be higher among disseminated cancer patients after multivariable analysis, suggesting DVT prophylaxis among these patients may need to be optimized. Future studies should focus on the long-term prognosis, particularly limb outcomes, in disseminated cancer patients.