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Chirurgia 2019 June;32(3):110-7

DOI: 10.23736/S0394-9508.18.04808-8


language: English

Preoperative factors affecting the activity of daily living after bypass surgery for critical limb ischemia: long-term outcomes

Shinsuke MII 1 , Atsushi GUNTANI 1, Eisuke KAWAKUBO 1, Yuko WATANABE 2, Hirofumi SHIMAZOE 3, Masaru ISHIDA 4

1 Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan; 2 Department of Rehabilitation, Saiseikai Yahata General Hospital, Kitakyushu, Japan; 3 Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan; 4 Department of Vascular Surgery, Steel Memorial Yawata Hospital, Kitakyushu, Japan

BACKGROUND: Improvement in the activity of daily living (ADL) is a goal of treatment for critical limb ischemia (CLI). The aim of this study was to identify factors affecting the in-hospital ADL and to investigate the relationship between change in the ADL after surgery and the long-term outcomes.
METHODS: A total of 271 patients who underwent infrainguinal bypass for CLI from 2005 to 2017 were reviewed. ADL was classified into 4 levels based on the Barthel Index (BI): BI ≥91, 90-61, 60-21, and ≤20. Patients were divided into 3 groups based on the change in the in-hospital ADL: group A (amelioration or discharge BI=100), group B (no change) and group C (deterioration or discharge BI=0). The predictors for amelioration or deterioration of the ADL were examined by a multivariate analysis and the three-year overall survival (OS) and amputation-free survival (AFS) of the three groups were determined by Kaplan-Meier’s method.
RESULTS: Significant factors influencing the amelioration and deterioration of the in-hospital ADL were the age, history of stroke, and BI on admission, and the age and Fontaine 4, respectively. The OS was significantly better in group A than groups B and C, and the AFS was better in group A than in group B.
CONCLUSIONS: A lower age, higher BI on admission, and no history of stroke are important factors influencing the decision-making regarding bypass surgery for CLI.

KEY WORDS: Activities of daily living - Ischemia - Coronary artery bypass - Frailty

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