In CLI, diabetes may not confer worse outcomes after revascularization
After adjustment for comorbidities, among patients with critical limb ischemia, those with diabetes had similar outcomes 30 days after revascularization than those without diabetes, researchers reported.
In fact, among patients who underwent open surgery, those with diabetes had less risk for major adverse limb events than those without diabetes, although the difference was not significant in patients who had endovascular revascularization.
The researchers analyzed 8,887 patients from the vascular module of the National Surgical Quality Improvement Program who underwent open (n = 5,744; 50% with diabetes) or endovascular revascularization (n = 3,133; 62% with diabetes) for CLI between 2011 and 2014.
Among the cohort, those with diabetes were younger and more likely to be nonwhite, nonsmoking and obese.
Outcomes of interest included 30-day major adverse limb events, defined as major reintervention or amputation, and 30-day MACE, defined as MI, cardiac arrest, stroke or death.
Compared with those without diabetes, patients with diabetes were more likely to present with tissue loss (71% vs. 47%; P < .001) and were more likely to be treated with endovascular intervention (41% vs. 29%; P < .001), Patric Liang, MD, from the division of vascular and endovascular surgery, department of surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, and colleagues wrote.
After adjustment for baseline differences, the groups did not differ in 30-day mortality in the open-surgery group (diabetes, 3.1%; no diabetes, 2.8%; OR = 1.1; 95% CI, 0.7-1.5) or in the endovascular group (diabetes, 2.6%; no diabetes, 2.1%; OR = 1.2; 95% CI, 0.7-2), according to the researchers.
Length of stay was longer and 30-day readmission rates were higher in patients with diabetes, but these differences were not significant after adjustment for baseline differences.
Among those who underwent an open procedure, the rate of MACE at 30 days was higher among patients with diabetes (7% vs. 5.1%), but the difference was not significant after adjustment for baseline differences (OR = 1.2; 95% CI, 0.9-1.6), whereas the rate of major adverse limb events at 30 days was lower in patients with diabetes and remained so after adjustments (8.1% vs. 10%; OR = 0.7; 95% CI, 0.6-0.9), Liang and colleagues wrote.
Adjusted 30-day outcomes did not differ by diabetes status in patients who underwent an endovascular procedure.
“Given these results, we believe the treating physician should not be discouraged from performing a bypass on an appropriately selected patient with diabetes, but instead should use the same criteria as would be used for a patient without diabetes to make this decision,” the researchers wrote. – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.