National Trends in Infrainguinal Bypass Outcomes: A Comparative Analysis Across Three Eras

Document Type

Conference Proceeding

Publication Date

11-1-2024

Publication Title

J Am Coll Surg

Abstract

Introduction: The declining volume of infrainguinal bypass (IIB) has raised concerns over contemporary outcomes compared to earlier periods. This study compares the outcomes of IIB in the contemporary era to earlier periods when IIB was more widely practiced. Methods: Patients undergoing IIB between 2003-2020 in the Vascular Quality Initiative (VQI) were stratified into three groups based on treatment era: early era (2003-2007, E1), intermediate era (2009-2013, E2), and contemporary era (2015-2019, E3). Multivariate Cox-regression was used to evaluate primary patency, reoperation, major amputation, and mortality. Results: A total of 39,538 patients were included. The average number of IIB/center dropped from 47.8/year to 25.3/year between 2003-2020 (Figure 1). Over the three time periods, there was a significant decrease in venous conduit use (p < 0.001). Worse outcomes at 1-year for primary patency (E1 88.6%, E2 86.1%, E3 84.4%, p < 0.001), re-intervention (E1 12.4%, E2 15.0%, E3 15.8%, p = 0.002) and major amputation (E1 9.4%, E2 9.1%, E3 10.4%, p = 0.009) were observed. Compared to E1 patients, higher hazard of loss of primary patency was observed for both E2 (HR 1.72 [1.51-1.95]) and E3 (HR 3.67 [3.23-4.17]) patients. Higher reintervention was also observed for both E2 (HR 1.38 [1.17-1.62]) and E3 (HR 1.41 [1.21-1.66]) patients. No difference was seen regarding major amputation and 30-day mortality. Conclusion: Patients undergoing IIB in the contemporary era have worse outcomes compared to those in earlier eras. This study emphasizes the need for further investigation into the factors contributing to the changing landscape of IIB outcomes. (Figure Presented).

Volume

239

Issue

5

First Page

S575

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