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Predictors Of Reintervention For Femoral And Popliteal Bypass In Lower Extremity Trauma: A National Trauma Data Bank(NTDB) Analysis
Maleek A. Masood, M.D., Afshin Parsikia, Evan Deutsch, MD, Constantine Troupes, MD, PhD, Aaron Ilano, MD, Ann Yufa, MD, Nadia Awad, MD.
Jefferson Einstein Healthcare Network, East Norriton, PA, USA.
Title: Predictors of Reintervention for Femoral and Popliteal Bypass in Lower Extremity Trauma: A National Trauma Data Bank (NTDB) AnalysisAuthors: Maleek A. Masood, Afshin Parsikia, Evan Deutsch, Constantine Troupes, Aaron Ilano, Ann Yufa, Nadia Awad
Objective: Identify factors that may be associated with reintervention following initial femoral/popliteal arterial revascularization following lower extremity trauma.
Methods: A retrospective review of data from the National Trauma Data Bank (NTDB) from 2017-2019 was performed. Thirty-three patients who underwent redo femoral or popliteal bypass in the same lower extremity during their hospitalization were identified. These patients were then separated on whether they received both bypass interventions at initial surgery (simultaneous bypass) or subsequent surgery (non-simultaneous bypass) during their hospitalization. Univariate analysis of simultaneous bypass versus non-simultaneous bypass was conducted. Statistically significant variables were then entered in a multivariate logistic regression to identify initial factors associated with need for reoperation and subsequent bypass.
Results: 23 patients underwent simultaneous femoral or popliteal bypass, and 10 patients underwent non-simultaneous bypass. For patients in the non-simultaneous bypass group, median time to reoperation was 1380 minutes. These patients were more likely to have sustained more severe injury as indicated by significantly elevated Injury Severity Score (ISS). These patients were also more likely to have an open knee wound compared to simultaneous group (50% vs. 9% p<0.05) and fracture of lower leg (90% vs. 43% p<0.05). After controlling for ISS, fracture of the lower leg was a significant predictor of non-simultaneous bypass (Table 1).
Conclusion: Patients with high ISS (>16), and/or fracture of the lower leg are at higher risk for missed injury and may require subsequent reintervention. This may suggest in the setting of high ISS and/or lower leg fracture the surgeon should evaluate for concomitant femoral and popliteal artery injury to provide any necessary repair at initial surgical intervention to avoid need for reoperation.
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| Table 1: Logistic Regression |
| Non-simultaneous | Odds ratio | SE | P-value | [95% conf. | interval] |
| ISS > 16 | 10.402 | 10.444 | 0.020 | 1.454 | 74.430 |
| Fracture of lower leg, including ankle | 14.614 | 18.422 | 0.033 | 1.235 | 172.883 |
| *Model includes ISS > 16, Fracture of lower leg including ankle, Fracture of femur, and blunt variable |
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