(PC034) The Effect of Diabetes Type on Suprainguinal Bypass Outcomes

Objectives: Existing research suggests that diabetes mellitus (diabetes) negatively affects vascular surgery outcomes, but specific data on suprainguinal bypass (SIB) are lacking. This study examines the association between diabetes management and SIB outcomes.

Methods: We performed a retrospective cohort study of all patients undergoing SIB for chronic limb-threatening ischemia (CLTI) in the Vascular Quality Initiative from 2009-2023. Patients were divided into cohorts based on management: nondiabetic (NDM), diet-controlled diabetic (DCDM), non-insulin-dependent diabetic (NIDDM), and insulin-dependent diabetic (IDDM). Baseline and intraoperative characteristics were reported for all groups. Modified Poisson regression was used for perioperative outcomes. The primary outcome was perioperative mortality. Secondary outcomes included postoperative complications, graft occlusion at discharge, major amputations, Major Adverse Limb Events (MALE), and Major Adverse Cardiac Events (MACE).

Results: There were 4,760 NDM patients (70.2%), 274 DCD patients (4.0%), 878 NIDDM patients (12.9%), and 832 IDDM patients (12.9%). On adjusted analysis, perioperative mortality was not significantly associated with diabetes management type (DCD: RR 1.27 [0.73-2.21], p=0.40; NIDDM: RR 0.95 [0.65-1.41], p=0.80; IDDM: RR 1.30 [0.89-1.89], p=0.20). DCD was associated with a higher risk of complications (RR 1.32 [1.09-1.60], p=0.005), as was IDDM (RR 1.27 [1.12-1.44], p< 0.001), and graft occlusion (RR 3.28 [1.18-9.13], p=0.023), while NIDDM (RR 0.42 [0.10-1.76], p=0.24) and IDDM (RR 1.48 [0.59-3.70], p=0.40) were not. The risk of major amputation was significantly associated with all diabetes management types compared to NDM (DCD: RR 1.94 [1.32-2.85], p< 0.001; NIDDM: RR 2.00 [1.56-2.55], p< 0.001; IDDM: RR 2.22 [1.73-2.84], p< 0.001). NIDDM (RR 1.39 [1.17-1.65], p< 0.001) and IDDM (RR 1.55 [1.31-1.83], p< 0.001) were associated with higher odds of MALE. There was no significant association between MACE and diabetes management.

Conclusions: CLTI DM patients undergoing suprainguinal bypass have similar perioperative mortality rates compared to NDM. DM is associated with higher rates of postoperative complications, major amputations, and MALE. The data suggest diet-controlled diabetics may benefit from preoperative medical management. Patients with diabetes and CLTI may require preoperative optimization and increased monitoring post-surgery due to higher complication and major amputation risks.