Critical limb ischaemia in patients over 80 years of age: Options in a district general hospital

Abstract

A total of 114 reconstructions were performed in 82 octogenarian patients and the results compared with those of 33 patients who had primary amputation. The operative mortality rate was higher after amputation (45 versus 11 per cent) and the mean survival less (25 versus 34 months). Quality of life assessment using a Rosser scale suggested that, although there was no improvement in the 38 per cent with a failed reconstruction, there was a significant improvement in the 62 per cent whose reconstruction remained patent. There was minimal improvement in quality of life after primary amputation and this was due to relief of pain. Costs (including the costs of revisions and community costs) were assessed in detail. Although the mean total operative costs of reconstruction were higher than those of amputation (10,222 pounds versus 6475 pounds) this was more than offset by the high community costs of amputation. The total cost of reconstruction was 13,546 pounds, compared with 33,095 pounds for amputation. Following reconstruction 66 per cent of those patients independent before critical limb ischaemia occurred were able to return to their own home; only 33 per cent of amputees were able to do so.

Predicting Adverse Postoperative Outcomes in Patients Aged 80 Years or Older

“…Many studies have attempted to define the risk indicators of morbidity and mortality associated with anesthesia and surgery in the general population 5–8 . Several studies have also reported mortality of octogenarians after specific types of surgery 9–19 . However, many had limited sample size, and none examined the potential impact of intraoperative events on outcome.…”

Lower Extremity Arterial Reconstruction in Octogenarians and Older

“…The superiority in outcomes when comparing revascularization versus either no intervention or primary amputation in elderly patients with severe PAD has been well described. 7, 10-15 Furthermore, functional outcomes and overall costs have also been studied and favor limb salvage over amputation in the elderly. 15-18 The outcomes of specifically open, infrainguinal LEAR in those ≥ 80 on a national level, however, have been less well defined.…”

“…7, 10-15 Furthermore, functional outcomes and overall costs have also been studied and favor limb salvage over amputation in the elderly. 15-18 The outcomes of specifically open, infrainguinal LEAR in those ≥ 80 on a national level, however, have been less well defined. Our study represents the largest retrospective review of 30-day outcomes following open LEAR in patients ≥ 80.…”

Postoperative Outcomes According to Preoperative Medical and Functional Status after Infrainguinal Revascularization for Critical Limb Ischemia in Patients 80 Years and Older

“…To date, we identified eight published studies addressing lower extremity revascularization in patients older than 80 with PAD. 1,2,[5][6][7][8][9][10] Each of these studies reviews results after open surgery and presents a similar theme: lower extremity revascularization in octogenarians appears safe, effective, and better than the alternative therapy of amputation. However, these studies, all of which were retrospective in nature, suffer from severe selection bias.…”