Back to 2016 Annual Symposium Abstacts

Objectives: In 2009, the Society for Vascular Surgery established objective performance goals (OPG) for lower extremity bypass (LEB) for patients with critical limb ischemia (CLI). However, these OPG excluded all patients with ESRD and prosthetic conduit. Using data from the Vascular Study Group of New England (VSGNE), our group proposed new OPG for the ESRD and prosthetic conduit populations. The goal of this study was to validate these proposed OPG in the NSQIP procedure targeted database.
Methods: All patients who underwent LEB for CLI were identified in the 2011-2013 NSQIP procedure targeted files for LEB. Patients were stratified by ESRD and prosthetic status. 30-day outcomes included Major Adverse Limb Event(MALE), Major Adverse Cardiovascular Event(MACE), and amputation. Outcomes were compared between the VSGNE and NSQIP using the chi square test.
Results: 3724 patients were identified in NSQIP(3609 VSGNE). Demographics between groups were similar: ESRD (9.5% VSGNE, 8% NSQIP,p=.50); prosthetic conduit: (27.7% VSGNE, 28.4% NSQIP,p=.45). In the ESRD group, MALE was not different between VSGNE (5.2%) and NSQIP groups (6.4%);p=0.52. MACE was also similar (12.5% VSGNE, 11.7% NSQIP,p=0.76), as was amputation (3.2% VSGNE, 3.0% NSQIP,p=0.88). For prosthetic patients, MALE was higher in NSQIP (7.9%) versus 5.5% in the VSGNE,p=.03. There was no difference in MACE (8.5% VSGNE, 7.6% NSQIP,p=0.45). Finally, amputation in NSQIP was higher at 4.0% versus VSGNE at 2.3%,p=.03.
Conclusions: The proposed ESRD OPG were validated by the NSQIP cohort; however, the proposed prosthetic OPG for 30 day MALE and amputation appear too low for the population represented by the NSQIP procedure targeted dataset.