Impact of the Timing of Foot Tissue Resection on Outcomes in Patients Undergoing Revascularization for Chronic Limb-Threatening Ischemia

The objective of this study is to describe utilization of revascularization and tissue resection in patients with chronic limb-threatening ischemia (CLTI) and determine whether the timing of resection impacts outcomes. Revascularizations for CLTI were queried (ACS-NSQIP 2011-2015). Outcomes included 30-day major adverse limb events (MALE), major adverse cardiac events (MACE), length of stay (LOS), operative time, 30-day readmissions, and wound infections. Groups included revascularization alone, revascularization/tissue resection during the same procedure (concurrent), or revascularization/delayed tissue resection (delayed). Resections were debridement or transmetatarsal amputations. Multivariate logistic regression determined risk-adjusted effects of tissue resection on outcomes. There was no difference in overall 30-day MACE or MALE between groups (P= .70 andP= .35, respectively). Length of stay (6.1 days revascularization alone vs 7.8 days concurrent vs 8.7 days delayed,P< .0001) was longer in patients who underwent any tissue resection. Highest 30-day readmission and operative time was the concurrent group (P= .02 andP< .0001, respectively). Wound infection was highest in the delayed group (1.4% revascularization alone vs 1.3% concurrent vs 6.2% delayed,P< .0001). After risk adjustment, timing of resection did not impact LOS for concurrent and delayed groups compared to revascularization alone (bothP< .0001). Debridement and minor amputations can be done concurrently in patients undergoing revascularization for CLTI.

Automated summary

This study aimed to investigate the utilization of revascularization and tissue resection in patients with CLTI and assess whether the timing of resection affects outcomes. Both concurrent and delayed tissue resection did not impact major limb or cardiac events within 30 days compared to revascularization alone, but did result in longer length of stay.