TY - JOUR
T1 - The Impact of Pre-Operative Anaemia on One Year Amputation Free Survival and Re-Admissions in Patients Undergoing Vascular Surgery for Peripheral Arterial Disease
T2 - a National Vascular Registry Study
AU - Birmpili, Panagiota
AU - Cromwell, David A.
AU - Li, Qiuju
AU - Johal, Amundeep S.
AU - Atkins, Eleanor
AU - Waton, Sam
AU - Pherwani, Arun D.
AU - Williams, Robin
AU - Richards, Toby
AU - Nandhra, Sandip
N1 - Funding Information:
Panagiota Birmpili was supported by a Clinical Research Fellowship grant by the Vascular Society of Great Britain and Ireland and the British Society of Interventional Radiology. Eleanor Atkins was supported by a Joint Royal College of Surgeons of England and Circulation Foundation Research Fellowship. This study was undertaken as part of the work of the National Vascular Registry (NVR), which is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and is funded by NHS England and the Welsh Government. The authors had complete access to the study data that support this publication. The funding bodies had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2023
PY - 2023/8
Y1 - 2023/8
N2 - Objective: Anaemia is common among patients undergoing surgery, but its association with post-operative outcomes in patients with peripheral arterial disease (PAD) is unclear. The aim of this observational population based study was to examine the association between pre-operative anaemia and one year outcomes after surgical revascularisation for PAD. Methods: This study used data from the National Vascular Registry, linked with an administrative database (Hospital Episode Statistics), to identify patients who underwent open surgical lower limb revascularisation for PAD in English NHS hospitals between January 2016 and December 2019. The primary outcome was one year amputation free survival. Secondary outcomes were one year re-admission rate, 30 day re-intervention rate, 30 day ipsilateral major amputation rate and 30 day death. Flexible parametric survival analysis and generalised linear regression were performed to assess the effect of anaemia on one year outcomes. Results: The analysis included 13 641 patients, 57.9% of whom had no anaemia, 23.8% mild, and 18.3% moderate or severe anaemia. At one year follow up, 80.6% of patients were alive and amputation free. The risk of one year amputation or death was elevated in patients with mild anaemia (adjusted HR 1.3; 95% CI 1.15 – 1.41) and moderate or severe anaemia (aHR 1.5; 1.33 – 1.67). Patients with moderate or severe anaemia experienced more re-admissions over one year (adjusted IRR 1.31; 1.26 – 1.37) and had higher odds of 30 day re-interventions (aOR 1.22; 1.04 – 1.45), 30 day ipsilateral major amputation (aOR 1.53; 1.17 – 2.01), and 30 day death (aOR 1.39; 1.03 – 1.88) compared with patients with no anaemia. Conclusion: Pre-operative anaemia is associated with lower one year amputation free survival and higher one year re-admission rates following surgical revascularisation in patients with PAD. Research is required to evaluate whether interventions to correct anaemia improve outcomes after lower limb revascularisation.
AB - Objective: Anaemia is common among patients undergoing surgery, but its association with post-operative outcomes in patients with peripheral arterial disease (PAD) is unclear. The aim of this observational population based study was to examine the association between pre-operative anaemia and one year outcomes after surgical revascularisation for PAD. Methods: This study used data from the National Vascular Registry, linked with an administrative database (Hospital Episode Statistics), to identify patients who underwent open surgical lower limb revascularisation for PAD in English NHS hospitals between January 2016 and December 2019. The primary outcome was one year amputation free survival. Secondary outcomes were one year re-admission rate, 30 day re-intervention rate, 30 day ipsilateral major amputation rate and 30 day death. Flexible parametric survival analysis and generalised linear regression were performed to assess the effect of anaemia on one year outcomes. Results: The analysis included 13 641 patients, 57.9% of whom had no anaemia, 23.8% mild, and 18.3% moderate or severe anaemia. At one year follow up, 80.6% of patients were alive and amputation free. The risk of one year amputation or death was elevated in patients with mild anaemia (adjusted HR 1.3; 95% CI 1.15 – 1.41) and moderate or severe anaemia (aHR 1.5; 1.33 – 1.67). Patients with moderate or severe anaemia experienced more re-admissions over one year (adjusted IRR 1.31; 1.26 – 1.37) and had higher odds of 30 day re-interventions (aOR 1.22; 1.04 – 1.45), 30 day ipsilateral major amputation (aOR 1.53; 1.17 – 2.01), and 30 day death (aOR 1.39; 1.03 – 1.88) compared with patients with no anaemia. Conclusion: Pre-operative anaemia is associated with lower one year amputation free survival and higher one year re-admission rates following surgical revascularisation in patients with PAD. Research is required to evaluate whether interventions to correct anaemia improve outcomes after lower limb revascularisation.
KW - Amputation
KW - Anaemia
KW - Peripheral arterial disease
KW - Revascularisation
KW - United Kingdom
KW - Vascular surgery
UR - http://www.scopus.com/inward/record.url?scp=85162905338&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2023.05.003
DO - 10.1016/j.ejvs.2023.05.003
M3 - Article
C2 - 37169135
AN - SCOPUS:85162905338
SN - 1078-5884
VL - 66
SP - 204
EP - 212
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 2
ER -