In patients with chronic limb-threatening ischemia (CLTI) and diabetes, 30-day post-revascularization outcomes are similar to those observed in CLTI patients without diabetes, according to a study in the Journal of Vascular Surgery. Patients with diabetes, however, appeared to have fewer major adverse limb events (MALEs) following bypass surgery, the researchers found.
The investigators identified 8887 patients from the 2011-2014 National Surgical Quality Improvement Program vascular module who were scheduled to undergo infrainguinal revascularization for CLTI. Specifically, patients with diabetes and without diabetes were compared in regard to presentation, comorbidities, surgical approach, and outcomes at 30 days. Additionally, the researchers compared the 2 patient groups for 30-day MALEs and 30-day major adverse cardiovascular events (MACEs), which included major reintervention or amputation and myocardial infarction, cardiac arrest, stroke, or death, respectively.
During the 2011-2014 study period, patients underwent either open (n = 5744) or endovascular (n = 3143) surgical treatment for CLTI. Patients with diabetes were significantly more likely to have undergone endovascular treatment vs endovascular treatment (41% vs 29%; P<.001). Tissue loss was significantly greater in diabetes patients vs non-diabetes patients at baseline (71% vs 47%, respectively; P<.001).
No differences were observed for 30-day mortality outcomes in the crude analysis (open: 3.1% vs 2.8% [P=.53]; endovascular: 2.6% vs 2.1% [P=.37]) or after adjustment for differences at baseline (open: odds ratio [OR] 1.1 [95% CI 0.7-1.5]; endovascular: OR 1.2 [95% CI 0.7-2.0). Compared with patients without diabetes, patients with diabetes had longer lengths of hospital stay (open: 6 days vs 8 days, respectively [P<.001]; endovascular: 2 days vs 3 days, respectively [P<.001]).
Higher 30-day readmission rates were also observed in diabetes patients vs patients without diabetes following open (21% vs 18%, respectively; P<.01) and endovascular (20% vs 15%, respectively; P<.01) intervention. In the adjusted analysis, however, differences in 30-day readmission rates were no longer significant. Additionally, the adjusted analysis revealed lower rates of MALEs in patients with vs without diabetes (OR 0.7; 95% CI 0.6-0.9) and similar rates of MACEs between the 2 groups (OR 1.2; 95% CI 0.9-1.6).
“Prolonged length of stay and readmission in patients with diabetes is not due to underlying diabetic disease but likely secondary to other baseline comorbidities, such as higher rates of tissue loss,” the researchers concluded. “Concern for worse perioperative outcomes in patients with diabetes after lower extremity bypass is unsubstantiated and should not discourage a physician from performing an open bypass.”
Liang P, Soden PA, Zettervall SL, et al. Treatment outcomes in diabetic patients with chronic limb-threatening ischemia.J Vasc Surg. 2018;68(2):487-494.