Reshma B. Patel1, Daniel J. Bertges1, Peter Callas1, Andres Schanzer2, Philip P. Goodney3, Michael A. Ricci1, Jack L. Cronenwett3, Andrew C. Stanley1, Julie E. Adams1, For the Vascular Surgery Group of New England
1University of Vermont College of Medicine, Burlington, VT; 2University of Massachusetts Medical School, Worchester, MA; 3Dartmouth-Hitchcock Medical School, Lebanon, NH.
OBJECTIVES: The purpose of this study was to evaluate the impact of gender on late functional outcomes of lower extremity bypass (LEB).
METHODS: We reviewed 3,301 patients (1,060; 32% females) undergoing LEB in the Vascular Surgery Group of New England from January 2003 to June 2010 to assess procedural outcomes, independent living, and ambulatory status according to preoperative baseline. Logistic regression models adjusted for differences between genders and potential confounders (age, race, smoking, indication, preoperative ambulation, statin use, conduit, and length of follow up). Ambulation and living status were analyzed by life table analysis.
RESULTS: On univariate analysis woman had less CAD (35% vs. 40 %, p< 0.001), smoking (75% vs. 89%, p=0.002), and autogenous conduits (63% vs. 71%, p< 0.001). Women had higher rates of reoperation for thrombosis (4% vs. 2%; OR 2.09, p<0.001) or infection (2% vs. 1%; OR 2.36, p=0.02) without differences in graft patency (94% vs. 95%; p=0.25) or mortality (2.1% vs. 2.1%; p=0.84) at discharge. Multivariate analysis showed fewer women were discharged home (63% vs. 73%; OR 0.72, p<0.001) and ambulating at discharge (90% vs. 93%; OR 0.65, p=0.009) regardless of preoperative ambulation. At long-term follow-up fewer women lived independently (HR 1.46, p=0.06) and significantly fewer were ambulatory (HR 1.65, p=0.004) (Figure).
CONCLUSIONS: Women have similar procedural-related complications but slightly inferior early and late functional outcomes after LEB. These findings may help define physician and patient expectations in women before revascularization.
AUTHOR DISCLOSURES: J. E. Adams, Nothing to disclose; D. J. Bertges, Nothing to disclose; P. Callas, Nothing to disclose; J. L. Cronenwett, Nothing to disclose; P. P. Goodney, Nothing to disclose; R. B. Patel, Nothing to disclose; M. A. Ricci, Nothing to disclose; A. Schanzer, Nothing to disclose; A. C. Stanley, Nothing to disclose.
Posted April 2012