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Outcomes After Peripheral Artery Revascularization
Study Questions:
What are the rates of subsequent inpatient hospitalization, focusing on admission for major adverse limb events (MALE) within 1 year after peripheral artery revascularization, and factors associated with 1-year MALE hospitalization?
Methods:
The study investigators examined 381,415 patients undergoing peripheral artery revascularization between January 1, 2009, and September 30, 2014, in the Premier Healthcare Database for the primary outcome of 1-year MALE hospitalization. Secondary outcomes included 1-year outpatient endovascular revascularization and limb-related, cardiovascular, and all-cause inpatient hospitalizations. Multivariable logistic regression was used to identify factors associated with 1-year MALE hospitalization.
Results:
Among 381,415 revascularized patients, within 1 year post-index revascularization, 10.3% (n = 10,182) had a hospitalization for MALE, 11.0% (n = 42,056) had an outpatient endovascular revascularization, 18.8% (n = 71,663) had a limb-related hospitalization, 12.8% (n = 48,875) had a cardiovascular hospitalization, and 38.9% (n = 148,457) had any inpatient hospitalization. Over the study period, limb-related, cardiovascular, and all-cause hospitalizations decreased, whereas rates of outpatient endovascular revascularizations increased. Male sex, black race, Medicare and Medicaid insurance, diabetes, renal insufficiency, heart failure, smoking, baseline critical or acute limb ischemia, surgical revascularization, and noncardiology operator specialty were significantly associated with increased risk of MALE hospitalization.
Conclusions:
The authors concluded that hospitalization for MALE occurs in 1 in 10 patients within 1 year after peripheral revascularization, and is associated with patient and procedural factors.
Perspective:
This study reports that 1 in 10 peripheral artery disease patients undergoing limb revascularization was hospitalized for MALE within the subsequent year. Furthermore, an additional 11% underwent outpatient endovascular revascularization within that year. Demographic factors, comorbid conditions, and procedural factors (including male sex, black race, insurance under Medicaid or Medicare, diabetes, renal insufficiency, heart failure, smoking, initial intervention for critical or acute limb ischemia, surgical revascularization, and certain operator characteristics) were significantly associated with 1-year hospitalization for MALE, which may help clinicians to identify high-risk patients. However, given the study design, these risk factors should be validated in additional studies. Strategies that address these risk factors, including better management of comorbidities and multidisciplinary team-based care, may improve the outcomes of peripheral artery revascularization, but need to be tested prospectively.
Keywords: Comorbidity, Diabetes Mellitus, Endovascular Procedures, Glycosuria, Renal, Heart Failure, Ischemia, Myocardial Revascularization, Peripheral Arterial Disease, Primary Prevention, Renal Insufficiency, Smoking, Vascular Diseases
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