Discharge Destination and One-Year Mortality in Acute Limb Ischemia Survivors after Revascularization: A Multicenter Registry Study.

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2026-05-02 DOI:10.1016/j.jvs.2026.04.027

Naoki Yoshioka, Yosuke Hata, Takuya Haraguchi, Shunsuke Kojima, Kenji Ogata, Tatsuro Takei, Shuko Iwata, Riho Suzuki, Haruya Yamane, Daichi Yoshii, Daisuke Matsuda, Eiji Koyama, Tomoki Uchikawa, Yasuhiro Morita, Osamu Iida, Itsuro Morishima

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引用次数: 0

Abstract

Objective: Acute limb ischemia may impair functional status and hinder return home after hospitalization, even in patients who survive to discharge. However, the associations among discharge destination, clinical characteristics, and outcomes have not been fully evaluated.

Methods: Using a multicenter registry, we analyzed 769 patients with acute limb ischemia who underwent revascularization between July 2011 and March 2025 and survived to discharge. Non-home discharge was defined as transfer to another hospital or nursing facility. Multivariable logistic regression incorporating baseline and procedural variables was performed to identify determinants of non-home discharge. One-year mortality after discharge was compared between the home and non-home discharge groups.

Results: Non-home discharge occurred in 287 (37.3 %) patients. Multivariable analysis demonstrated that advanced age, non-ambulatory status, frailty, prior cerebrovascular disease, hypoalbuminemia, and receipt of public assistance were independently associated with non-home discharge, as was severe ischemia (Rutherford category IIb/III). Procedural factors, including the need for surgical revascularization and inadequate distal perfusion (final Tibial Infrapopliteal Perfusion Index grade 0-1) were also associated with non-home discharge. When stratified by cumulative risk burden (0-2, 3-5, ≥6 factors), the incidence of non-home discharge increased stepwise (18%, 50%, and 92%, respectively; p < 0.001). One-year mortality was significantly higher among patients with non-home discharge than among those discharged home (21.2% vs. 7.6%; log-rank p < 0.001).

Conclusions: More than one-third of patients with acute limb ischemia were unable to return home after revascularization. Discharge destination was independently associated with baseline vulnerability, disease severity, and procedural factors, and was linked to increased 1-year mortality.

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血运重建术后急性肢体缺血幸存者的出院目的地和一年死亡率：一项多中心登记研究。

目的：急性肢体缺血可能会损害功能状态并阻碍住院后的回家，即使是存活到出院的患者。然而，出院目的地、临床特征和结局之间的关系尚未得到充分评估。方法：采用多中心登记，我们分析了2011年7月至2025年3月期间接受血运重建术并存活至出院的769例急性肢体缺血患者。非家庭出院被定义为转移到另一家医院或护理机构。采用包含基线和程序变量的多变量逻辑回归来确定非家庭出院的决定因素。将出院后一年的死亡率与非出院组进行比较。结果：287例（37.3%）患者出现非居家出院。多变量分析表明，高龄、非活动状态、虚弱、既往脑血管疾病、低白蛋白血症和接受公共援助与非家庭出院独立相关，严重缺血也与非家庭出院独立相关（卢瑟福分类IIb/III）。手术因素，包括手术血运重建的需要和远端灌注不足（最终胫骨膝下灌注指数0-1级）也与非居家出院有关。当按累积风险负担（0-2、3-5、≥6个因素）分层时，非家庭出院发生率依次增加（分别为18%、50%和92%，p < 0.001）。非出院患者的一年死亡率显著高于出院患者（21.2% vs. 7.6%; log-rank p < 0.001）。结论：超过三分之一的急性肢体缺血患者在血运重建术后无法回家。出院目的地与基线易感性、疾病严重程度和程序因素独立相关，并与1年死亡率增加相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.