Risk Score for One Year Mortality Following Emergent Infra-Inguinal Bypass.

The purpose of this study is to identify variables which places patients at higher risk for mortality following emergent infra-inguinal bypass. Further, this study will create a risk score for mortality following emergent infra-inguinal bypass to help tailor postoperative and long-term patient management. In the Vascular Quality Initiative, we identified 2126 patients who underwent emergent infra-inguinal artery bypass. Two primary outcomes were investigated : 30 day mortality following emergent infra-inguinal bypass; and, 1 year mortality following emergent infra-inguinal bypass. The first step in analysis was univariable analysis for each outcome with Chi-squared analysis for categorical variables and student t-test for comparison of means of ordinal variables. Next, binary logistic regression analysis was performed for each outcome utilizing variables which achieved a univariable P value < .10. Factors with a multivariable P-value < .05 were included in the risk score and points were weighted and assigned based on the respective regression beta-coefficient in the multivariable regression. Variables with a significant multivariable association (P<.05) with one year mortality were : increasing age; BMI less than 20 kg/m Discharge medications are the primary modifiable variable impacting survival after emergent infra-inguinal bypass surgery. In the absence of contra indication, all these patients should be discharged on antiplatelet, statin and anticoagulant medications after emergent infra-inguinal bypass as they significantly enhance survival. Social determinants of health do not impact survival amongst patients treated with emergent infra-inguinal bypass at VQI centers. A risk score for mortality at one year after emergent infra-inguinal bypass has been created that has excellent accuracy.

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