A systematic review and meta-analysis of risk factors for and incidence of 30-day readmission after revascularization for peripheral artery disease

Smith, Samuel; Matthews, Evan O.; Moxon, Joseph V.; Golledge, Jonathan

doi:10.1016/j.jvs.2019.01.079

Cited by 39 publications

(32 citation statements)

References 39 publications

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“…The national rate averages at 16.4%, with wound complications and MACE dominating the causes for readmission. 35 We found a significant decrease in overall costs associated with definitive correction of CLI. 36 interventions were completed by a single vascular surgeon, and there were changes in the clinical management algorithm over time due to experience and new technology.…”

Section: Discussionmentioning

confidence: 65%

WITHDRAWN: One-Year Freedom from Amputation, Survival, and Cost of Care following Tibial and Pedal Endovascular Interventions for Critical Limb Ischemia: The Role of Atherectomy and Drug-Eluting Stents

Desai

Baronofsky

Shukla

et al. 2020

Annals of Vascular Surgery

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Background: The impact of a coordinated, multispecialty limb salvage program combined with aggressive multi-tibial revascularization upon limb salvage rates, survival, and cost of care has not previously been elucidated. The purpose of this paper is to present a clinical management algorithm developed over a 4-year period that can significantly improve amputation-free survival in critical limb ischemia (CLI) patients. Methods: This study is a prospective, single center analysis to evaluate the clinical, quality of care, and financial outcomes in CLI patients who undergo aggressive revascularization and wound care. Patient demographics, comorbidities, and procedure details were measured with outcomes tabulated at the index procedure and at successive 3-month intervals to 1 year. Results: A total of 186 patients who underwent endovascular interventions for Rutherford 4+ CLI were followed for a 1-year period between 2016 and 2019. The average ankleebrachial index improved from 0.49 ± 0.21 prior to treatment to 0.74 ± 0.23 at 1 year (P < 0.001). The immediate technical success rate was 95.7%, defined as the number of patients with inline flow from the aorta to the foot. About 33.4% of patients required a minor amputation and 7.3% of patients required a major amputation by 1 year. Crude all-cause mortality at 1 year was 17.7%. The total direct cost of care was $31,797 at 1 year, but significantly lower for the atherectomy with the drug-eluting stent group ($24,442, P < 0.001). About 5.7% of patients eventually required open surgical bypass. Conclusions: Inline revascularization paired with a coordinated limb salvage program can significantly improve outcomes in CLI patients. Appropriate endovascular management of CLI patients can lead to durable results with a high amputation-free survival.

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Section: Discussionmentioning

confidence: 65%

WITHDRAWN: One-Year Freedom from Amputation, Survival, and Cost of Care following Tibial and Pedal Endovascular Interventions for Critical Limb Ischemia: The Role of Atherectomy and Drug-Eluting Stents

Desai

Baronofsky

Shukla

et al. 2020

Annals of Vascular Surgery

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“…The contribution to risk stratification in patients with PAD could be in identifying patients who also have evidence of heart failure (with preserved ejection fraction), a combination of entities with a particularly poor outcome. 91 , 92 hs-cTnT also appears to be a good predictor for all-cause mortality and MACE in lower extremity PAD patients. In comparison to NT-proBNP, the studies investigating hs-cTnT had more patients with chronic limb-threatening ischemia and were, therefore, more prone to MACE.…”

Section: Discussionmentioning

confidence: 93%

Plasma Biomarkers to Predict Cardiovascular Outcome in Patients With Peripheral Artery Disease

Kremers

Wübbeke

Mees

et al. 2020

ATVB

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Objective: Patients with lower extremity peripheral artery disease (PAD) are at increased risk of major adverse cardiovascular events. Numerous plasma biomarkers have been investigated in lower extremity PAD, but none are used for clinical risk assessments. We aimed to provide a comprehensive overview of biomarker testing in PAD as a first step to improve risk stratification. Approach and Results: A systematic literature review in MEDLINE/PubMed, Cochrane, and Embase was performed, identifying all studies investigating plasma biomarkers in association with cardiovascular events and mortality in lower extremity PAD. Forty-seven studies comprising 21 473 PAD patients met our criteria and were included. Effect estimates were provided by the studies based on a minimum follow-up of 1 year. Meta-analyses were performed by pooling studies per biomarker for each end point. Patients with increased high-sensitivity CRP (C-reactive protein) levels had a relative risk of 1.86 (1.48–2.33) for major adverse cardiovascular events and a relative risk of 3.49 (2.35–5.19) for mortality. Increased fibrinogen and d -dimer levels were associated with an increased relative risk of mortality of 2.08 (1.46–2.97) and 2.22 (1.24–3.98), respectively. Additionally, patients with increased NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity cTnT (cardiac troponin T) levels were at an even higher risk of mortality with relative risks of 4.50 (2.98–6.81) and 3.33 (2.70–4.10), respectively. Conclusions: This systematic review identifies promising biomarkers representing different pathophysiological processes implicated in lower extremity PAD, including high-sensitivity CRP, neutrophil-lymphocyte ratio, fibrinogen, d -dimer, NT-proBNP, and high-sensitivity cTnT. Clinical implementation should be preceded by a management study to test the utility of a combination of these markers for individual risk stratification. Ultimately, this may contribute to tailored treatment and increased effectiveness of current treatment strategies in PAD.

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“…There is substantial evidence of a higher prevalence of hospitalized PAD among Blacks than Whites (7)(8)(9)(10) and Native Americans also have high prevalence of PAD as compared with non-Hispanic Whites (11). However, there is limited information on the burden of PAD among other racial/ethnic minority groups (12), especially among the PAD inpatients (13).…”

Section: Introductionmentioning

confidence: 99%

Disparities in Peripheral Artery Disease Hospitalizations Identified Among Understudied Race-Ethnicity Groups

Chen

Zhang

Shi

et al. 2021

Front. Cardiovasc. Med.

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Background: To assess racial/ethnic differences in disease severity, hospital outcomes, length of stay and healthcare costs among hospitalized patients with peripheral artery disease (PAD).Methods: This study used data from the National Inpatient Sample (NIS) to explore the racial/ethnic disparities in PAD-related hospitalizations including presence of PAD with chronic limb threatened ischemia (CLI), amputation, in-hospital mortality, length of hospital stays and estimated medical costs. Race-ethnicity groups included non-Hispanic White, Black, Hispanic, Asian or Pacific Islander, Native American, and others (multiple races). Regression analyses adjusted for age, gender, Charlson Comorbidity Index, primary payer, patient location, bed size of the admission hospital, geographic region of the hospital, and rural/urban location of the hospital.Results: A total of 341,480 PAD hospitalizations were identified. Compared with non-Hispanic Whites, Native Americans had the highest odds of PAD with CLI (OR = 1.77, 95% CI: 1.61, 1.95); Black (OR = 1.71, 95% CI: 1.66, 1.76) and Hispanic (OR = 1.36, 95% CI: 1.31,1.41) patients had higher odds of amputation; Asian or Pacific Islanders had a higher mortality (OR = 1.20, 95% CI: 1.01,1.43), whereas Black (OR = 0.81, 95% CI: 0.76, 0.87) patients has a lower mortality; Asian or Pacific Islanders incurred higher overall inpatient costs (Margin = 30093.01, 95% CI: 28827.55, 31358.48) and most prolonged length of stay (IRR = 0.14, 95% CI: 0.09, 0.18).Conclusions: Our study identified elevated odds of amputation among Hispanic patients hospitalized with PAD as well as higher hospital mortality and medical expenses among Asian or Pacific Islander PAD inpatients. These two demographic groups were previously thought to have a lower risk for PAD and represent important populations for further investigation.

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A systematic review and meta-analysis of risk factors for and incidence of 30-day readmission after revascularization for peripheral artery disease

Cited by 39 publications

References 39 publications

WITHDRAWN: One-Year Freedom from Amputation, Survival, and Cost of Care following Tibial and Pedal Endovascular Interventions for Critical Limb Ischemia: The Role of Atherectomy and Drug-Eluting Stents

WITHDRAWN: One-Year Freedom from Amputation, Survival, and Cost of Care following Tibial and Pedal Endovascular Interventions for Critical Limb Ischemia: The Role of Atherectomy and Drug-Eluting Stents

Plasma Biomarkers to Predict Cardiovascular Outcome in Patients With Peripheral Artery Disease

Disparities in Peripheral Artery Disease Hospitalizations Identified Among Understudied Race-Ethnicity Groups

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