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Published on: September 22, 2020
Alcohol use disorder increases risk of major adverse limb events following lower-extremity revascularization for
Samantha N Machinski1, Mikayla Lowenkamp2, Lindsey Olivere2
1Division of Vascular Surgery, UPMC, Pittsburgh, PA.
Insights
Patients with alcohol use disorder (AUD) face higher risks of major adverse limb events, amputation, and mortality after lower extremity revascularization for chronic limb-threatening ischemia (CLTI). Identifying AUD preoperatively can improve risk assessment.
Area of Science:
- Vascular Surgery
- Addiction Medicine
- Cardiovascular Outcomes Research
Background:
- Chronic limb-threatening ischemia (CLTI) affects numerous patients, with a significant portion undergoing major amputation.
- Excessive alcohol consumption is linked to adverse cardiovascular outcomes, yet its impact on CLTI patients with alcohol use disorder (AUD) remains understudied.
Purpose of the Study:
- To investigate the association between alcohol use disorder (AUD) and major adverse limb events (MALE) in adults undergoing lower extremity revascularization for CLTI.
- To evaluate the impact of AUD on amputation and mortality rates in this patient population.
Main Methods:
- Retrospective analysis of electronic health records from a unified healthcare system (2016-2024).
- Inclusion of adult patients with CLTI undergoing index lower extremity revascularization (endovascular or open).
- AUD identified using validated ICD-10-CM codes; one-year MALE, major amputation, and mortality assessed using Fine Gray and Cox regression, risk-adjusted for competing mortality.
Main Results:
- Among 3,744 CLTI patients, 4.9% had AUD and were more likely male and tobacco users.
- AUD diagnosis was independently associated with increased risk of one-year MALE (sHR=1.29) and significantly higher risk of major amputation (sHR=1.94) and mortality (aHR=1.51).
- No significant association found between AUD and major revascularization failure (sHR=1.14).
Conclusions:
- Alcohol use disorder independently increases the risk of MALE, major amputation, and mortality in patients undergoing lower extremity revascularization for CLTI.
- Preoperative identification of AUD is crucial for refining risk stratification in this vulnerable patient group.
- Further research into AUD management strategies within vascular surgery is warranted.
Objective:
One in four patients with chronic limb-threatening ischemia (CLTI) undergo major amputation. Despite an established pathophysiological link between excessive alcohol consumption and adverse cardiovascular outcomes, the prevalence and impact of alcohol use disorder (AUD) among adult patients with CLTI has not been investigated. To address this gap, we sought to evaluate the association between AUD and major adverse limb events (MALE) among adults undergoing lower extremity revascularization for CLTI.
Methods:
Data were abstracted via Structured Query Language server queries of inpatient and outpatient electronic health records of the UPMC multi-hospital, unified health care system. We included index revascularization (endovascular or open) among adults with CLTI (2016-2024). Validated International Classification of Diseases, 10th Revision-Clinical Modification (ICD-10-CM) codes defined AUD. One-year outcomes of MALE (primary), major amputation, and major revascularization were compared with Fine-Gray regression risk-adjusted for competing mortality. Cumulative hazard curves and Cox modeling assessed these outcomes alongside 1-year mortality in sensitivity analyses. Multivariable regression was clustered by hospital and generated subdistribution (sHR) or adjusted (aHR) hazard ratios with 95% confidence intervals (CIs) for Fine-Gray or Cox modeling, respectively.
Results:
Among 3744 patients with CLTI undergoing revascularization (mean age, 69.8 ± 11.7 years; 61.0% male), 183 (4.9%) had an AUD diagnosis. Patients with an AUD diagnosis were more frequently male (84.2% vs 59.8%; P < .001) and concurrent tobacco users (56.3% vs 26.4%; P < .001). AUD correlated with an increased risk of 1-year MALE (35.6% vs 27.2%; P = .002). In Fine-Gray competing-mortality risk regression, AUD was independently associated with increased risk MALE (sHR, 1.29; 95% CI, 1.03-1.63; P = .029). Although major revascularization failed to reach significance (sHR, 1.14; 95% CI, 0.89-1.47; P = .295), AUD conferred higher 1-year risk of major amputation (sHR, 1.94; 95% CI, 1.65-2.36; P < .001) and mortality (aHR, 1.51; 95% CI, 1.09-2.09; P = .013).
Conclusions:
An AUD diagnosis independently conferred greater risk of MALE and mortality among adults undergoing index lower extremity revascularization for CLTI. These findings underscore the potential value of preoperative identification of AUD to refine risk stratification in this vulnerable, understudied population.
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