Bypass Thrombosis is the Most Common Reason for Unplanned Return to Operating Room After Lower Extremity Bypass for Chronic Limb-Threatening Ischemia

Background Return to operating room (ROR) is an important quality metric reflecting surgical outcomes. This study aimed to identify risk factors associated with ROR after lower extremity bypass (LEB) for chronic limb-threatening ischemia (CLTI). Methods A retrospective analysis was performed using the Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI) database for patients undergoing LEB for CLTI between 2007 and 2020. Patients were divided into two groups: Group I (ROR) and Group II (No ROR). Univariate and multivariate regression analyses were conducted to identify risk factors, with significance set at P < .05. Results Among 10 800 patients, 1443 (14%) required ROR. Factors significantly associated with increased ROR risk included African American race (OR 1.39, CI [1.18-1.63]), Medicaid insurance (OR 1.36, CI [1.06-1.75]), ambulatory with assistance (OR 1.21, CI [1.05-1.41]), discharge to rehabilitation (OR 2.98, CI [2.58-3.44]), transfer to other hospitals (OR 4.06, CI [2.38-6.93]), concomitant bypass (OR 1.46, CI [1.05-2.03]), infrageniculate graft insertion (OR 1.39, CI [1.15-1.67]), non-autologous biologic conduit (OR 1.71, CI [1.25-2.33]), and general anesthesia (OR 2.58, CI [1.25-5.33]). Female sex (OR 0.82, CI [0.71-0.95]) and aspirin use (OR 0.85, CI [0.73-0.99]) were protective. Bypass thrombosis was the most common reason for ROR. No significant trend in ROR reduction was observed over the study period. Conclusion Multiple clinical and operative factors increase ROR risk after LEB for CLTI. Risk stratification and targeted interventions are essential to minimize complications and improve patient outcomes.