Excessive alcohol use increases risk of amputation in CLTI patients
Heavy alcohol use—three or more drinks each day—should be considered a risk factor for poor outcomes in patients with chronic limb-threatening ischemia (CLTI), according to a new study published in the Journal of Vascular Surgery.[1]
Researchers at the University of Pittsburgh Medical Center health system retrospectively examined 3,744 patients with CLTI undergoing lower-extremity revascularization. They looked at whether the patients had alcohol use disorder (AUD) listed in their medical record and for any major adverse limb events (MALE) at one year. They found AUD was an independent risk factor with higher one-year risk of major amputation. The MALE rate was 35.6% for AUD patients and 27.2% for patients without AUD.
"An AUD diagnosis was associated with markedly worse limb-related and survival outcomes following index revascularization for CLTI. Our findings underscore the potential prognostic importance of preoperative AUD identification and support implementation of universal screening guidelines to improve perioperative risk stratification," explained lead author Samantha N. Machinski, a medical student at University of Pittsburgh School of Medicine, and colleagues.
Nearly 5% of patients had an AUD diagnosis. While 84.2% of AUD patients were men, 56.3% were also tobacco users.
The group pulled electronic medical record and searched for ICD-10-CM codes indicating an AUD diagnosis. These included those with a clinical diagnosis term indicating AUD, evidence of alcohol withdrawal or chronic alcohol-related harm defined as any health-related outcome directly attributed to alcohol.
The study's primary outcome was one-year MALE, including above-ankle amputation or major reintervention (surgical bypass or interposition grafting, thrombectomy or thrombolysis). Secondary one-year outcomes included individual items of the composite outcome MALE (major amputation, revascularization) and mortality. While major revascularization failed to reach significance, researchers said AUD patients had higher rates of amputation.
A subgroup analysis showed that endovascular revascularization was associated with a higher risk of MALE among patients with AUD. However, this association was not seen in patients who underwent open surgical revascularization. The researchers said this was consistent with evidence from recent trials showing open revascularization provided superior results for patients with AUD.
The group also noted that one in four patients with CLTI undergo a major amputation. This is a known link between excessive alcohol consumption and adverse cardiovascular outcomes, but its impact among CLTI patients was not known.
Reviewing these findings, the authors said the preoperative identification of AUD (and including it in patient risk stratification models) may help improve postoperative outcomes.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]