Fasciotomy is Associated With Higher 30-Day Mortality and Morbidities but Lower Amputation in Patients Undergoing Emergent Thrombectomy

Fasciotomy is often performed concurrently with emergent thrombectomy for acute limb ischemia to prevent compartment syndrome after reperfusion of the leg. This study examines the associated outcomes with fasciotomy by comparing those with cases without fasciotomy. Patients undergoing emergent thrombectomy were identified in American College of Surgeons National Surgical Quality Improvement Program databases 2005 to 2022 by Current Procedural Terminology codes. Cases were divided into those with concurrent fasciotomy and those without. Multivariable logistic regression was used to compare 30-day postoperative outcomes between the two groups. There were a total of 10,174 patients underwent emergent thrombectomy; 1961 patients (19.3%) had concurrent fasciotomy and 8213 patients (80.7%) did not. Multivariable analysis showed that those who underwent fasciotomy had significantly higher 30-day mortality, higher pulmonary complications, renal dysfunction, sepsis, bleeding requiring transfusion, unplanned return to the operation room, discharge not to home, and length of stay over 7 days (Table). However, patients who had fasciotomy had significantly lower 30-day major amputation (0.51% vs 1.01%; adjusted odds ratio [aOR], 0.41; 95% confidence interval [CI], 0.21-0.792; P = .01). Less than 1% (0.84%) of those who did not have fasciotomy at the index thrombectomy needed to return to the operating room for delayed fasciotomy. Approximately 20% of emergent thrombectomy needed concurrent fasciotomy. Although it is associated with higher mortality and morbidities, fasciotomy is associated with lower limb loss. Higher limb loss in the non-fasciotomy group is likely due to other confounding factors since the incidence of delayed fasciotomy is less than 1%.TableMultivariable analysis comparing the 30-day postoperative outcomes of patients with acute limb ischemia who had or had no fasciotomyFasciotomy (n = 1961), No. (%)No fasciotomy(n = 8213), No. (%)aOR for fasciotomy/no fasciotomy(95% CI)P-valueMortality355 (18.1)1135 (13.82)1.223 (1.053-1.421).01Cardiac complications138 (7.04)445 (5.42)1.08 (0.88-1.326).46Stroke48 (2.45)192 (2.34)0.948 (0.684-1.314).75Pulmonary events396 (20.19)1050 (12.78)1.394 (1.21-1.607)<.01Renal dysfunction182 (9.28)379 (4.61)1.512 (1.239-1.844)<.01Sepsis245 (12.49)635 (7.73)1.324 (1.12-1.565)<.01VTE58 (2.96)198 (2.41)1.037 (0.766-1.405).81Bleeding requiring transfusion745 (37.99)1727 (21.03)2.16 (1.927-2.421)<.01Wound complications200 (10.2)701 (8.54)1.155 (0.976-1.367).09Amputation10 (0.51)83 (1.01)0.408 (0.21-0.792).01Any unplanned reoperation624 (31.82)1886 (22.96)1.385 (1.239-1.549)<.01Unplanned reoperation for fasciotomy7 (0.36)69 (0.84)0.384 (0.175-0.841).02Discharge not to home966 (64.92)2608 (45.59)2.498 (2.181-2.86)<.01LOS over 7 days1359 (69.3)4036 (49.14)2.168 (1.941-2.421)<.0130-day readmission196 (9.99)751 (9.14)1.069 (0.904-1.263).44aOR, Adjusted odds ratio; CI, confidence interval; LOS, length of stay; VTE, venous thromboembolism. Open table in a new tab