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7. Quality of Life in Patients With Chronic Limb-Threatening Ischemia Treated With Revascularization

Author

Menard, Matthew T., Farber, Alik, Powell, Richard J., Rosenfield, Kenneth, Conte, Michael S., Hamza, Taye H., Kaufman, John A., Cziraky, Mark J., Creager, Mark A., Dake, Michael D., Jaff, Michael R., Reid, Diane, Sopko, George, White, Christopher J., Strong, Michael B., van Over, Max, Chisci, Emiliano, Goodney, Philip P., Gray, Bruce, Kayssi, Ahmed, Siracuse, Jeffrey J., Choudhry, Niteesh K., Maurao, Mick, Muluk, Satish, Belkin, Michael, Lyden, Sean, Shishehbor, Mehdi, Bajakian, Danielle, Duwayri, Yazan, Bowens, Nina, Nypaver, Timothy, Mukherjee, Dipankar, Obrand, Daniel, LaMuraglia, Glenn, Kalra, Manju, Bernardo, Nelson, Barshes, Neal, Lipsitz, Evan, Jenkins, J. Stephen, Gasper, Warren, Owens, Christopher, Pomposelli, Frank, Rogers, Kevin, Vouyouka, Ageliki, Passman, Marc, Pena, Constantino, Ramaiah, Venkatesh, Hoch, John, Bersin, Robert, Hayes, Greg, Ho, Karen, Shah, Aamir, Lum, Ying Wie, Darling, R. Clement, III, Aalami, Oliver, Zhou, Wei, Patel, Parag, Aziz, Abdulhameed, Halloran, Brian, Jung, Enjae, Mitchell, Erica, Turba, Ulku Cenk, Choi, Eric, Hiramoto, Jade, Owens, Christopher, Milner, Ross, Crawford, Robert, Ucuzian, Areck, Henke, Peter, Chaer, Rabih, Lahiri (Adams), Julie, Gelabert, Hugh, Safian, Robert, Mena-Hurtado, Carlos, Ihnat, Daniel, Rowe, Vincent, Kashyap, Vikram, Shaw, Palma, Korngold, Ethan, Lindsay, Thomas, Winkelaar, Gerrit, Mell, Matthew, DuVal, Bruce, Aziz, Faisal, Reed, Amy, Nazzal, Munier, Schanzer, Andres, Hamdan, Allen, Smeds, Matthew, Kalish, Jeffrey, Slaiby, Jeffrey, Androes, Mark, Hanover, Tod, Motaganahalli, Raghu, Chang, Catherine, Hye, Robert, Alexander, Jason, Ansel, Gary, Bohannon, Todd, Desai, Sapan, Hodgson, Kim, Hood, Douglas, Guzman, Randolph Pl, Giles, Kristina, Shah, Samir, Hawkins, Beau, Brothers, Thomas Edward, Azizzadeh, Ali, Charlton-Ouw, Kristofer, Khan, Sophia, Brooke, Benjamin S., Kabutey, Nii-Kabu, Sachar, Ravish, Dosluoglu, Hasan, Berman, Scott, Blebea, John, Taubman, Kevin, Douville, Yvan, Cox, Mitchell W., Davis, Joseph, Caps, Michael, Schneider, Peter, Abou-Zamzam, Ahmed, Feldman, Robert, von Mering, Gregory, Tan, Tze-Woei, Virk, Chiranjiv S., Zhang, Wayne, Bacharach, Michael, Seidman, Craig, Iafrati, Mark, Findeiss, Laura, Bailey, Charles, Shames, Murray, Lane, John, Baril, Donald, Hass, Stephen, Stone, Patrick, Sharma, Aditya, Tracci, Margaret, Mackenzie, Kent, Stoner, Michael, Starr, Jean, McAllister, David, Singh, Niten, Tsai, Shirling, Kinlay, Scott, Macsata, Robyn, Neville, Richard, Rundback, John, McGinigle, Kate, Vallabhaneni, Raghu, Espinoza, Andrey, Azarbal, Amir, Longo, G. Matthew, Kovach, Richard, Soukas, Peter, Metzger, Chris, Artis, Andre, Bachinsky, William, Armstrong, Ehrin, Hattler, Brack, Chandra, Venita, Schor, Jonathan, Bianchi, Christian, Kiang, Sharon, Ben-Arie, Eyal, Verta, Michael, Wilkinson, Julia, Hurie, Justin, Kopriva, David, Molnar, Robert, Chun, Linda Jun, Azene, Ezana, Davis, Clark, Blazick, Elizabeth, Henao, Steve, Proffitt, Trent, Herman, Christine, Nathan, Derek, Chang, Robert, Lane, John, Mureebe, Leila, Chen, Jerry, Semel, Marcus, Fecteau, Scott, Mehta, Manish, Nagpal, Sudhir, Shammas, Nicolas, Kujath, Scott, Beasley, Robert, Vogel, Todd, Hedayati, Nasim, Brooks, James, Nelson, Peter, Parrack, Inkyong, Bernik, Thomas, Dexter, David, Brown, Kellie, Huang, Joe, Wu, Timothy, Hacker, Robert, Garland, Brandon Tyler, Griffin, Joseph, Laskowski, Igor, Pfau, Steven, Duncan, Audra, Trachtenberg, Jeffrey, Gordon, Ian, Tan, Tze-Woei, Aulivola, Bernadette, Zayed, Mohamed, Venermo, Maarit, Hill, Andrew, Wickremesekera, Janaka Kesara, Ketteler, Erika, Michelagnoli, Stefano, Bannazadeh, Mohsen, Sikalas, Nicholas, Khashram, Manar, Vasudevan, Thodur, Simmons, Justin, Osborne, Nicholas, Fox, Charles, and Vallabhaneni, Raghuveer

Published
2024
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8. Contemporary outcomes of traumatic popliteal artery injury repair from the popliteal scoring assessment for vascular extremity injury in trauma study

Author

O'Banion, Leigh Ann, Dirks, Rachel, Saldana-Ruiz, Nallely, Farooqui, Emaad, Yoon, William J, Pozolo, Cara, Fox, Charles J, Crally, Alexis, Siada, Sammy, Nehler, Mark R, Brooke, Benjamin S, Beckstrom, Julie L, Kiang, Sharon, Boggs, Hans K, Chandra, Venita, Ho, Vy T, Zhou, Wei, Lee, Ashton, Bowens, Nina, Cho, Yan, Woo, Karen, Ulloa, Jesus, and Magee, Gregory A

Subjects
Patient Safety, Clinical Research, Physical Injury - Accidents and Adverse Effects, Injuries and accidents, Good Health and Well Being, Adult, Amputation, Arterial Pressure, Decision Support Techniques, Female, Humans, Injury Severity Score, Limb Salvage, Male, Platelet Aggregation Inhibitors, Popliteal Artery, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Ultrasonography, Doppler, United States, Vascular Patency, Vascular Surgical Procedures, Vascular System Injuries, Young Adult, Lower extremity trauma, Popliteal artery, Popliteal injury, Popliteal vein, Vascular trauma, Amputation, Surgical, Medical and Health Sciences, Cardiovascular System & Hematology
Abstract

ObjectiveTraumatic popliteal artery injuries are associated with the greatest risk of limb loss of all peripheral vascular injuries, with amputation rates of 10% to 15%. The purpose of the present study was to examine the outcomes of patients who had undergone operative repair for traumatic popliteal arterial injuries and identify the factors independently associated with limb loss.MethodsA multi-institutional retrospective review of all patients with traumatic popliteal artery injuries from 2007 to 2018 was performed. All the patients who had undergone operative repair of popliteal arterial injuries were included in the present analysis. The patients who had required a major lower extremity amputation (transtibial or transfemoral) were compared with those with successful limb salvage at the last follow-up. The significant predictors (P < .05) for amputation on univariate analysis were included in a multivariable analysis.ResultsA total of 302 patients from 11 institutions were included in the present analysis. The median age was 32 years (interquartile range, 21-40 years), and 79% were men. The median follow-up was 72 days (interquartile range, 20-366 days). The overall major amputation rate was 13%. Primary repair had been performed in 17% of patients, patch repair in 2%, and interposition or bypass in 81%. One patient had undergone endovascular repair with stenting. The overall 1-year primary patency was 89%. Of the patients who had lost primary patency, 46% ultimately required major amputation. Early loss (within 30 days postoperatively) of primary patency was five times more frequent for the patients who had subsequently required amputation. On multivariate regression, the significant perioperative factors independently associated with major amputation included the initial POPSAVEIT (popliteal scoring assessment for vascular extremity injury in trauma) score, loss of primary patency, absence of detectable immediate postoperative pedal Doppler signals, and lack of postoperative antiplatelet therapy. Concomitant popliteal vein injury, popliteal injury location (P1, P2, P3), injury severity score, and tibial vs popliteal distal bypass target were not independently associated with amputation.ConclusionsTraumatic popliteal artery injuries are associated with a significant rate of major amputation. The preoperative POPSAVEIT score remained independently associated with amputation after including the perioperative factors. The lack of postoperative pedal Doppler signals and loss of primary patency were highly associated with major amputation. The use of postoperative antiplatelet therapy was inversely associated with amputation, perhaps indicating a protective effect.

Published
2021

9. Popliteal scoring assessment for vascular extremity injuries in trauma study.

Author

O'Banion, Leigh Ann, Dirks, Rachel, Farooqui, Emaad, Saldana-Ruiz, Nallely, Yoon, William J, Pozolo, Cara, Fox, Charles, Crally, Alexis, Siada, Sammy, Nehler, Mark R, Brooke, Benjamin S, Beckstrom, Julie L, Kiang, Sharon, Boggs, Hans K, Chandra, Venita, Ho, Vy T, Zhou, Wei, Lee, Ashton, Bowens, Nina, Cho, Yan, Woo, Karen, Ulloa, Jesus, and Magee, Gregory A

Subjects
Knee Joint, Popliteal Artery, Humans, Knee Injuries, Ultrasonography, Doppler, Blood Pressure Determination, Prognosis, Limb Salvage, Injury Severity Score, Risk Assessment, Risk Factors, Retrospective Studies, Reproducibility of Results, Predictive Value of Tests, Blood Pressure, Decision Support Techniques, Time Factors, Adult, Middle Aged, United States, Female, Male, Fractures, Bone, Young Adult, Vascular System Injuries, Joint Dislocations, Amputation, Surgical, Lower extremity trauma, Popliteal artery, Popliteal injury, Vascular trauma, Physical Injury - Accidents and Adverse Effects, Clinical Research, Patient Safety, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Injuries and accidents, Good Health and Well Being, Amputation, Medical and Health Sciences, Cardiovascular System & Hematology
Abstract

ObjectiveTraumatic popliteal vascular injuries are associated with the highest risk of limb loss of all peripheral vascular injuries. A method to evaluate the predictors of amputation is needed because previous scores could not be validated. In the present study, we aimed to provide a simplified scoring system (POPSAVEIT [popliteal scoring assessment for vascular extremity injuries in trauma]) that could be used preoperatively to risk stratify patients with traumatic popliteal vascular injuries for amputation.MethodsA review of patients sustaining traumatic popliteal artery injuries was performed. Patients requiring amputation were compared with those with limb salvage at the last follow-up. Of these patients, 80% were randomly assigned to a training group for score generation and 20% to a testing group for validation. Significant predictors of amputation (P < .1) on univariate analysis were included in a multivariable analysis. Those with P < .05 on multivariable analysis were assigned points according to the relative value of their odds ratios (ORs). Receiver operating characteristic curves were generated to determine low- vs high-risk scores. An area under the curve of >0.65 was considered adequate for validation.ResultsA total of 355 patients were included, with an overall amputation rate of 16%. On multivariate regression analysis, the risk factors independently associated with amputation in the final model were as follows: systolic blood pressure

Published
2021

16. Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

Author

George, Elizabeth L, Chen, Rui, Trickey, Amber W, Brooke, Benjamin S, Kraiss, Larry, Mell, Matthew W, Goodney, Philip P, Johanning, Jason, Hockenberry, Jason, and Arya, Shipra

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Rehabilitation, Cardiovascular, Clinical Research, Patient Safety, Management of diseases and conditions, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, 7.1 Individual care needs, Good Health and Well Being, Age Factors, Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal, Databases, Factual, Elective Surgical Procedures, Endovascular Procedures, Female, Frail Elderly, Frailty, Geriatric Assessment, Health Status Disparities, Humans, Male, Middle Aged, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States, Vascular Surgical Procedures, Risk Analysis Index, Open abdominal aortic aneurysm repair, Endovascular abdominal aortic aneurysm repair, Nonhome discharge, Medical and Health Sciences, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences
Abstract

ObjectiveFrailty is increasingly recognized as a key determinant in predicting postoperative outcomes. Centers that see more frail patients may not be captured in risk adjustment, potentially accounting for poorer outcomes in hospital comparisons. We aimed to (1) determine the effect of frailty on long-term mortality in patients undergoing elective abdominal aortic aneurysm (AAA) repair and (2) evaluate the variability in frailty burden among centers in the Vascular Quality Initiative (VQI) database.MethodsPatients undergoing elective open and endovascular AAA repair (2003-2017) were identified, and those with complete data on component variables of the VQI-derived Risk Analysis Index (VQI-RAI) and centers with ≥10 AAA repairs were included. VQI-RAI characteristics are sex, age, body mass index, renal failure, congestive heart failure, dyspnea, preoperative ambulation, and functional status. Frailty was defined as VQI-RAI ≥35 based on prior work in surgical patients using other quality improvement databases. This corresponds to the top 12% of patients at risk in the VQI. Center-level VQI-RAI differences were assessed by analysis of variance test. Relationships between frailty and survival were compared by Kaplan-Meier analysis and the log-rank test for open and endovascular procedures. Multivariable hierarchical Cox proportional hazards regression models were calculated with random intercepts for center, controlling for frailty, race, insurance, AAA diameter, procedure type, AAA case mix, and year.ResultsA total of 15,803 patients from 185 centers were included. Mean VQI-RAI scores were 27.6 (standard deviation, 5.9; range, 4-56) and varied significantly across centers (F = 2.41, P < .001). The percentage of frail patients per center ranged from 0% to 40.0%. In multivariable analysis, frailty was independently associated with long-term mortality (hazard ratio, 2.88; 95% confidence interval, 2.6-3.2) after accounting for covariates and center-level variance. Open AAA repair was not associated with long-term mortality after adjusting for frailty (hazard ratio, 0.98; 95% confidence interval, 0.86-1.13). There was a statistically significant difference in the percentage of frail patients compared with nonfrail patients who were discharged to a rehabilitation facility or nursing home after both open (40.5% vs 17.8%; P < .0001) and endovascular repair (17.7% vs 4.6%; P < .0001).ConclusionsThere is considerable variability of preoperative frailty among VQI centers performing elective AAA repair. Adjusting for center-level variation, frailty but not procedure type had a significant association with long-term mortality; however, frailty and procedure type were both associated with nonhome discharge. Routine measurement of frailty preoperatively by centers to identify high-risk patients may help mitigate procedural and long-term outcomes and improve shared decision-making regarding AAA repair.

Published
2020

32. Design of the PReferences for Open Versus Endovascular Repair of Abdominal Aortic Aneurysm (PROVE-AAA) Trial

Author

Gaudette, Cory, Grippa, Francisco, Voorhees, Amy, Moore, Kayla, Dowse, Catherine, Barbey, Sarah, Galla, Ann, Grove, Lori, Belanger, Karen, Karamoto, Angela, Patel, Veep, Bigda, Susan, Jabori, Sinan, Chun, Kevin, Beckstrom, Julie, Maloney, Maria, Schieber, Molly, Zoble, Adam, Anderson, Stephanie, Morrison, Michael, Columbo, Jesse A., Kang, Ravinder, Spangler, Emily L., Newhall, Karina, Brooke, Benjamin S., Dosluoglu, Hasan, Lee, Eugene S., Raffetto, Joseph D., Henke, Peter K., Tang, Gale S., Mureebe, Leila, Kougias, Panagoitis, Johanning, Jason, Arya, Shipra, Scali, Salvatore T., Stone, David H., Suckow, Bjoern D., Orion, Kristine, Halpern, Vivienne, O'Connell, Jessica, Inhat, Daniel, Nelson, Peter, Tzeng, Edith, Zhou, Wei, Barry, Michael, Sirovich, Brenda, and Goodney, Philip P.

Published
2020
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33. Patient information sources when facing repair of abdominal aortic aneurysm

Author

Anderson, Peter B., Wanken, Zachary J., Perri, Jennifer L., Columbo, Jesse A., Kang, Ravinder, Spangler, Emily L., Newhall, Karina, Brooke, Benjamin S., Dosluoglu, Hasan, Lee, Eugene S., Raffetto, Joseph D., Henke, Peter K., Tang, Gale L., Mureebe, Leila, Kougias, Panagiotis, Johanning, Jason, Arya, Shipra, Scali, Salvatore T., Stone, David H., Suckow, Bjoern D., Orion, Kristine, Halpern, Vivienne, O'Connell, Jessica, Inhat, Daniel, Nelson, Peter, Tzeng, Edith, Zhou, Wei, Barry, Michael, Sirovich, Brenda, and Goodney, Philip P.

Published
2020
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47. Physical Function in the Hospital Is Associated With Patient-Centered Outcomes in an Inpatient Rehabilitation Facility

Author

Johnson, Joshua K., Fritz, Julie M., Brooke, Benjamin S., LaStayo, Paul C., Thackeray, Anne, Stoddard, Gregory, and Marcus, Robin L.

Subjects
United States. Centers for Medicare and Medicaid Services, Hospital patients -- Patient outcomes, Medical centers, Ambulatory care facilities, Medical schools, Health
Abstract

Objective. Poor knowledge of the relationships between physical function (PF) in the hospital and patient outcomes in an inpatient rehabilitation facility (IRF) limits the identification of patients most appropriate for discharge to an IRF. This study aimed to test for independent associations between PF measured via the AM-PAC '6-clicks' basic mobility short form in the hospital and outcomes in an IRF. Methods. This was a retrospective cohort study. Primary data were collected from an acute hospital and IRF at 1 academic medical center. Associations were tested between PF at hospital admission or discharge and PF improvement in the IRF, discharge from the IRF to the community, and 30-day hospital events by estimating adjusted relative risk (aRR) using modified Poisson regression and the relative difference in IRF length of stay (LOS) using Gamma regression. Results. A total of 1323 patients were included. Patients with moderately low, (aRR = 1.50; 95% CI = 1.15-1.93), moderately high (aRR = 1.52; 95% CI = 1.16-2.01), or high (aRR = 1.37; 95% CI = 1.02-1.85) PF at hospital discharge were more likely than those with very low PF to improve their PF while in the IRF. These same patients were more likely to discharge from IRF to the community and had significantly shorter IRF LOS. Hospital-measured PF did not differentiate risk for 30-day hospital events. Conclusion. Patients with moderate--but not very low or very high--PF measured near the time of acute hospital discharge were likely to achieve meaningful PF improvement in an IRF. They also had a shorter IRF LOS so may be ideal candidates for discharge to IRF. Prospective studies with larger samples are necessary to test this assertion. Impact. Providers in the hospital should identify patients with moderate PF near the time of hospital discharge as those who may benefit most from post-acute rehabilitation in an IRF., Medicare costs on post-acute care (PAC) utilization exceeded $59 billion in 2013, nearly tripling since 2001. (1) Therefore, new policies aim to improve the value of PAC utilization in the [...]

Published
2020
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