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Home > Vascular Annual Meeting^® > PP39. Have Changes in Vascular Interventions...

PP39. Have Changes in Vascular Interventions Improved Limb Salvage?

Roman Nowygrod1, Natalia N. Egorova2, Stephanie Guillerme2, Nicholas Morrissey1, Annetine C. Gelijns2, James F McKinsey3
1Columbia University Medical Center, New York, NY; 2Mount Sinai School of Medicine, New York, NY; 3Columbia University Medical Center, New York, NY

OBJECTIVES: Over the past decade, dramatic shifts in the management of vascular disease have increased safety and reduced mortality. This study examines the impact of these changes on limb salvage success.

METHODS: NY State in-patient hospital discharge data from 1998-2007 were queried for patients who underwent either open or endovascular (endo) lower extremity revascularization procedures (LER) or amputations. Patients were selected by cross referencing ICD9 diagnostic and procedural codes. Proportions were analyzed by chi-squared analysis, continuous variables by t test and trends by the Cochran-Armitage test.

RESULTS: Over time the combined rate of LE surgery decreased by 13%, with major shifts occurring in the type of surgery. While the per capita (100,000 population, age>40) volume for endo LER doubled (34.6 to 71.7), the number of major amputations and open LER declined by 38% (44.5 to 30.3) and 40% (104.2 to 62.2), respectively. Interventions for patients with critical ischemia (CI) declined by 17% (88.1 to 73.5), but those for claudication increased by 61% (17.7 to 28.6). Endo LER interventions for both claudication and CI nearly tripled (286%, 271%). Though the total number of surgeries on patients age 80+ with CI has increased, rate per capita decreased by 14%, compared to a 20% decline in other age groups. The incidence of significant comorbidities has substantially increased; for claudicants: diabetes by 19%, HTP 30%, COPD 40%, CAD 21% and renal 230%; for patients with CI: HTP, COPD, and CAD incidence was higher (23%, 32%, 8% respectively) but diabetics decreased by 6%. Cardiac, respiratory and infection complications after amputation have increased by 29%, 28% and 10%. For LER, respiratory complications increased 9% but cardiac and infection complications actually decreased (8 and 27%) Similar trends were observed for patients with combined LER and amputation. Length of stay (LOS) declined significantly in all groups with an overall decrease of 30% (p<.05).

CONCLUSIONS: Despite the fact that patients, whether treated for claudication or CI, are sicker, older and have more complications, the rate of major amputations and LOS has significantly decreased due presumably to widespread and successful use of endo LER and/or to earlier interventions driven by the safety of endo LER.

AUTHOR DISCLOSURES: R. Nowygrod, None; N.N. Egorova, None; S. Guillerme, None; N. Morrissey, None; A.C. Gelijns, None; J.F. McKinsey, None.