This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Trends and outcomes after surgical lower limb revascularization in England. BJS 2011; 98: 1373-1382.
Published: 26th May 2011
Authors: P. W. Moxey, D. Hofman, R. J. Hinchliffe, K. Jones, M. M. Thompson, P. J. E. Holt et al.
Background
The aim was to analyse contemporary data on the number of surgical revascularization procedures performed each year in England, and their outcome.
Method
Hospital Episode Statistics and Office for National Statistics data were used to quantify numbers and identify factors associated with outcome after all femoropopliteal and femorodistal bypass procedures performed between 2002 and 2006. Outcome measures were repeat bypass, major amputation, death and a composite measure. Single‐level multivariable logistic regression modelling was used to quantify the effect of these variables on outcome.
Results
A total of 21 675 femoropopliteal and 3458 femorodistal bypass procedures were performed. Mean in‐hospital mortality rates were 6·7 and 8·0 per cent respectively. One‐year survival rates were 82·8 and 79·1 per cent; both increased over the study interval. The mean 1‐year major amputation rate after femoropopliteal bypass was 10·4 per cent, which decreased significantly over the 5 years (P < 0·001); after distal bypass the rate of 20·8 per cent remained unchanged (P = 0·456). Diabetes mellitus and chronic kidney disease were significant predictors of adverse outcome for both procedures: odds ratio (OR) at 1 year 1·56 (95 per cent confidence interval 1·46 to 1·67; P < 0·001) and 2·15 (1·88 to 2·45; P < 0·001) respectively for femoropopliteal bypass. Previous femoral angioplasty was associated with an increased rate of major amputation 1 year after proximal bypass (OR 1·18, 1·05 to 1·33; P = 0·004).
Conclusion
Although all mortality rates are improving, the major amputation rate remains high after femorodistal bypass. Adverse events occurred after 37·6 per cent of femoropopliteal and 49·7 per cent of femorodistal bypasses; diabetes and chronic renal failure were the main predictors of poor outcome. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Full text