Preoperative Nutritional Status is an Independent Predictor of the Long-Term Outcome in Patients Undergoing Open Bypass for Critical Limb Ischemia

Mii, Shinsuke; Guntani, Atsushi; Kawakubo, Eisuke; Shimazoe, Hirofumi; Ishida, Masaru

doi:10.1016/j.avsg.2019.09.015

Cited by 19 publications

(17 citation statements)

References 15 publications

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“…7 showed that malnutrition, demonstrated using the GNRI and Mini Nutritional Assessment, is associated with poorer early outcomes in patients hospitalized for CLI. Although the present study was shorter than the previously reported studies, 2 , 3 , 5 , 6 similar results were obtained. Taking these findings together, there is mounting evidence that preoperative nutritional status is an independent predictor of long-term mortality in patients with CLI.…”

Section: Discussionsupporting

confidence: 87%

“…Mii et al. 3 also demonstrated that both the GNRI and CONUT scores have close relationships with early and long-term survival and mortality-related outcomes in patients with CLI undergoing open bypass. In addition, Matsuo et al.…”

Section: Discussionmentioning

confidence: 95%

“…2 Conversely, Mii et al. 3 found that neither the GNRI nor the CONUT score was independently associated with five-year LS in patients undergoing infrainguinal bypass for CLI. In the present study, we have shown that LS is positively related to preoperative nutritional status, which is consistent with the finding that it is a significant predictor of WH.…”

Section: Discussionmentioning

confidence: 98%

“…Several groups have described the use of nutritional indices calculated using multiple parameters to predict both early and longer-term outcomes in patients with PAD. 1–7 However, to the best of our knowledge, there have been no studies of the relationship between preoperative nutritional status assessed using a nutritional index and WH. Therefore, we believe that this is the first study to show a positive relationship between these parameters in patients with tissue loss.…”

Section: Discussionmentioning

confidence: 99%

“…Several previous studies have shown that objective nutritional indices, calculated using multiple simple parameters, are associated with the prognosis of patients with PAD. 1–7 However, in the studies conducted to date, death, major amputation, or cardiovascular events were set as the endpoints, and none have described the relationship between nutritional index and wound healing (WH), which is one of the most important goals of treatment for ischemic tissue loss.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative nutritional status is independently associated with wound healing in patients undergoing open surgery for ischemic tissue loss

Tanaka

Okazaki

et al. 2021

Vascular

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Objectives The aim of this study was to determine the relationship between preoperative nutritional status and wound healing in patients undergoing surgical reconstruction for ischemic tissue loss. Methods The preoperative nutritional status of patients who underwent surgical reconstruction for ischemic tissue loss for the years 2011–2018 was retrospectively estimated using the Controlling Nutritional Status (CONUT) score. Patients were allocated to two groups: Group I, normal nutrition or mild malnutrition (CONUT score ≤4), and Group II, moderate-to-severe malnutrition (CONUT score ≥5). Wound healing was set as the primary endpoint and major amputation and death as the secondary endpoints. The wound healing, limb salvage, and overall survival rates were calculated after two years using the Kaplan–Meier method, and Cox proportional hazards regression analysis was performed to determine which variables were independently associated with these outcomes. Results Forty-eight patients with missing values for the CONUT score were excluded. A total of 174 limbs in 147 patients were studied (Group I: 115 limbs in 100 patients; Group II: 59 limbs in 47 patients). The mean duration of the study was 519 ± 270 days. The Kaplan–Meier curves showed that wound healing in Group I was superior to that in Group II (Group I vs. II: two-year wound healing, 97% vs. 79%; time to 50% wound healing, 83 vs. 150 days, p < 0.001), and multivariate analysis showed that the CONUT score was an independent predictor of wound healing (hazard ratio, 0.63; 95% confidence interval, 0.41–0.98; p = 0.038). Conclusions Patients with better preoperative nutritional status are more likely to experience wound healing earlier than those with excessive malnutrition.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative nutritional status is independently associated with wound healing in patients undergoing open surgery for ischemic tissue loss

Tanaka

Okazaki

et al. 2021

Vascular

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The utility of geriatric nutritional risk index to predict outcomes in chronic limb‐threatening ischemia

Li¹,

Arora²,

Ikeoka³

et al. 2021

Cathet Cardio Intervent

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Objectives: To assess geriatric nutritional risk index (GNRI) in patients with chronic limb-threatening ischemia (CLTI).Background: The prevalence of CLTI continues to rise, with major amputation and mortality remaining prominent. Frailty is a vital risk factor for adverse outcomes in cardiovascular care. The GNRI is a nutrition-based surrogate for frailty that has been utilized in Southeast Asia to predict adverse events in CLTI. It has not yet been evaluated in a primarily Western population, nor in the context of wound healing.Methods: Between 8August 2017 and April 2019, we identified patients undergoing endovascular interventions for CLTI at our institution, categorized into low GNRI (≤ 94, frail) versus normal GNRI (> 94, reference). We analyzed the risks of major adverse limb events (MALE), its individual components [mortality, major amputation, and target vessel revascularization (TVR)], amputation free survival (AFS), and wound healing using Kaplan-Meier and multivariate cox-proportional hazard regression analyses.Results: A total of 255 patients were included in the analysis, with follow up of 14 ± 9.1 months. Lower GNRI was associated with higher cumulative event rates for MALE (71.0% vs. 43.3%, p < 0.001), mortality (34.3% vs. 15.2%, p < 0.001), major amputation (31.2% vs. 15.8%, p = 0.002), and freedom from AFS (56.0% vs. 28.2%, p < 0.001). There was a trend toward lower TVR and higher wound healing with higher GNRI score.Conclusions: Our single-center, retrospective evaluation of GNRI (as a surrogate for frailty) correlated with increased risks of MALE, mortality, and major amputation. Future directions should focus not only on the recognition of these patients, but riskfactor modification to optimize long-term outcomes.

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The Geriatric Nutritional Risk Index predicts amputation after infrapopliteal angioplasty in critical limb ischemia patients

Ruangsetakit

Navikaputra

Pruekprasert

et al. 2023

Asian Journal of Surgery

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Preoperative Nutritional Status is an Independent Predictor of the Long-Term Outcome in Patients Undergoing Open Bypass for Critical Limb Ischemia

Cited by 19 publications

References 15 publications

Preoperative nutritional status is independently associated with wound healing in patients undergoing open surgery for ischemic tissue loss

Preoperative nutritional status is independently associated with wound healing in patients undergoing open surgery for ischemic tissue loss

The utility of geriatric nutritional risk index to predict outcomes in chronic limb‐threatening ischemia

The Geriatric Nutritional Risk Index predicts amputation after infrapopliteal angioplasty in critical limb ischemia patients

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