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Initial Post-Operative Visit Absenteeism is Associated With Worse Amputation-Free Survival after Tibial Angioplasty

  • Anthony N Grieff
    Affiliations
    Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
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  • Sapna Syal
    Affiliations
    Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
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  • William E Beckerman
    Affiliations
    Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
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  • ShihYau Huang
    Correspondence
    Correspondence to: ShihYau Huang, MD, Division of Vascular Surgery and Endovascular Therapy, One Robert Wood Johnson Place, MEB 541, New Brunswick, NJ 08901, USA
    Affiliations
    Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
    Search for articles by this author
Published:December 22, 2021DOI:https://doi.org/10.1016/j.avsg.2021.11.025

      Abstract

      Objectives

      Tibial revascularization is often performed in the setting of critical limb ischemia and tissue loss requiring close patient monitoring in the early post-operative period for worsening gangrene and/or ischemia. Multiple studies have shown loss to follow-up is an independent risk factor for poor outcomes in several vascular procedures. Therefore, we evaluated the risk factors relating to loss to follow up against outcomes in patients undergoing tibial endovascular procedures with the hypothesis that poor post-operative visit compliance is associated with decreased amputation-free survival rates.

      Methods

      We performed a single-institution retrospective chart review of patients who underwent therapeutic endovascular tibial revascularization between 2014–2018. Patient follow-up and outcomes of death or major amputation (trans-tibial/trans-femoral) were followed up to 36-months post-operatively. Patients who had undergone previous infra-geniculate interventions or reached mortality/major amputation within 30-days post-operatively were excluded from analysis.

      Results

      We identified 89 patients who met inclusion criteria. The overall rate of attendance at less than <1 month, 1–6 months, 6–15 months and 15–36 months post-operatively were 60%, 64%, 60 and 40% respectively. 16% of patients had complete loss to follow-up. Patients without tissue loss (≤ Rutherford 4) were less likely to attend early <1 month and 1–6 month follow-up intervals. Notably, absenteeism from the first immediate post-operative visit was a significant risk factor for further absenteeism at 1–6 months (51% vs. 26%; P = 0.01) and at greater than 6-month follow-up (48% vs. 31%; P = 0.05). Compared to the cohort of all patients, failure to follow-up within 1 month was associated with a decrease in attendance from 64% to 26% at 1–6 months and 63–31% at more than 6 months. Missing the first post-operative visit was also associated with decreased amputation-free survival (P = 0.04).

      Conclusions

      Absenteeism from the first post-operative visit is associated with worse amputation-free survival and a significant risk factor for further absenteeism from post-operative care. Given these results, ensuring close immediate post-operative follow up is essential to improving outcomes in patients undergoing tibial revascularization.
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