Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany
Aim: To present the short- and long-term outcomes of lower extremity bypass (LEB) surgery in patients with critical limb-threatening ischaemia (CLTI), comparing diabetic (DM) and non-diabetic (non-DM) patients. Methods: Retrospective analysis of anonymised data from a nationwide health insurance com...
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MDPI AG
2023-12-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/12/1/38 |
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| author | Johanna Surmann Philipp Meyer Jasmin Epple Thomas Schmitz-Rixen Dittmar Böckler Reinhart T. Grundmann |
| author_facet | Johanna Surmann Philipp Meyer Jasmin Epple Thomas Schmitz-Rixen Dittmar Böckler Reinhart T. Grundmann |
| author_sort | Johanna Surmann |
| collection | DOAJ |
| description | Aim: To present the short- and long-term outcomes of lower extremity bypass (LEB) surgery in patients with critical limb-threatening ischaemia (CLTI), comparing diabetic (DM) and non-diabetic (non-DM) patients. Methods: Retrospective analysis of anonymised data from a nationwide health insurance company (AOK). Data from 22,633 patients (DM: <i>n</i> = 7266; non-DM: <i>n</i> = 15,367; men: <i>n</i> = 14,523; women: <i>n</i> = 8110; mean patient age: 72.5 years), who underwent LEB from 2010 to 2015, were analysed. The cut-off date for follow-up was December 31, 2018 (mean follow-up period: 55 months). Results: Perioperative mortality was 10.0% for DM and 8.2% for non-DM (<i>p</i> < 0.001). Patients with crural/pedal bypasses (<i>n</i> = 8558) had a significantly higher perioperative mortality (10.3%) than those with above-the-knee (<i>n</i> = 7246; 5.8%; <i>p</i> < 0.001) and below-the-knee bypasses (<i>n</i> = 6829; 8.9%; <i>p</i> = 0.003). The 9-year survival rates in DM patients were significantly worse, at 21.5%, compared to non-DM, at 31.1% (<i>p</i> < 0.001). This applied to both PAD stage III (DM: 34.4%; non-DM: 45.7%; <i>p</i> < 0.001) and PAD stage IV (DM: 18.5%; non-DM: 25.0%; <i>p</i> < 0.001). Patients with crural/pedal bypasses had a significantly inferior survival rate (25.5%) compared to those with below-the-knee (27.7%; <i>p</i> < 0.001) and above-the-knee bypasses (31.7%; <i>p</i> < 0.001). Conclusion: Perioperative and long-term outcomes regarding survival and major amputation rate for CLTI patients undergoing LEB are consistently worse for DM patients compared to non-DM patients. |
| first_indexed | 2024-03-08T09:57:40Z |
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| id | doaj.art-4717bffbca2d479787a73f86f279f2a0 |
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| language | English |
| last_indexed | 2024-03-08T09:57:40Z |
| publishDate | 2023-12-01 |
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| spelling | doaj.art-4717bffbca2d479787a73f86f279f2a02024-01-29T13:46:41ZengMDPI AGBiomedicines2227-90592023-12-011213810.3390/biomedicines12010038Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in GermanyJohanna Surmann0Philipp Meyer1Jasmin Epple2Thomas Schmitz-Rixen3Dittmar Böckler4Reinhart T. Grundmann5Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Vascular and Endovascular Surgery, University Hospital Frankfurt am Main, 60596 Frankfurt am Main, GermanyDepartment of Vascular and Endovascular Surgery, Goethe University Frankfurt, 60629 Frankfurt am Main, GermanyDepartment of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, GermanyGerman Institute for Vascular Healthcare Research (DIGG), German Society for Vascular Surgery and Vascular Medicine, 10115 Berlin, GermanyAim: To present the short- and long-term outcomes of lower extremity bypass (LEB) surgery in patients with critical limb-threatening ischaemia (CLTI), comparing diabetic (DM) and non-diabetic (non-DM) patients. Methods: Retrospective analysis of anonymised data from a nationwide health insurance company (AOK). Data from 22,633 patients (DM: <i>n</i> = 7266; non-DM: <i>n</i> = 15,367; men: <i>n</i> = 14,523; women: <i>n</i> = 8110; mean patient age: 72.5 years), who underwent LEB from 2010 to 2015, were analysed. The cut-off date for follow-up was December 31, 2018 (mean follow-up period: 55 months). Results: Perioperative mortality was 10.0% for DM and 8.2% for non-DM (<i>p</i> < 0.001). Patients with crural/pedal bypasses (<i>n</i> = 8558) had a significantly higher perioperative mortality (10.3%) than those with above-the-knee (<i>n</i> = 7246; 5.8%; <i>p</i> < 0.001) and below-the-knee bypasses (<i>n</i> = 6829; 8.9%; <i>p</i> = 0.003). The 9-year survival rates in DM patients were significantly worse, at 21.5%, compared to non-DM, at 31.1% (<i>p</i> < 0.001). This applied to both PAD stage III (DM: 34.4%; non-DM: 45.7%; <i>p</i> < 0.001) and PAD stage IV (DM: 18.5%; non-DM: 25.0%; <i>p</i> < 0.001). Patients with crural/pedal bypasses had a significantly inferior survival rate (25.5%) compared to those with below-the-knee (27.7%; <i>p</i> < 0.001) and above-the-knee bypasses (31.7%; <i>p</i> < 0.001). Conclusion: Perioperative and long-term outcomes regarding survival and major amputation rate for CLTI patients undergoing LEB are consistently worse for DM patients compared to non-DM patients.https://www.mdpi.com/2227-9059/12/1/38bypass surgeryopen revascularisationdiabetescritical limb-threatening ischaemiaperipheral artery diseaselong-term survival |
| spellingShingle | Johanna Surmann Philipp Meyer Jasmin Epple Thomas Schmitz-Rixen Dittmar Böckler Reinhart T. Grundmann Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany Biomedicines bypass surgery open revascularisation diabetes critical limb-threatening ischaemia peripheral artery disease long-term survival |
| title | Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany |
| title_full | Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany |
| title_fullStr | Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany |
| title_full_unstemmed | Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany |
| title_short | Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany |
| title_sort | long term outcome of lower extremity bypass surgery in diabetic and non diabetic patients with critical limb threatening ischaemia in germany |
| topic | bypass surgery open revascularisation diabetes critical limb-threatening ischaemia peripheral artery disease long-term survival |
| url | https://www.mdpi.com/2227-9059/12/1/38 |
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