Surgical management and outcomes of acute limb ischaemia at 2 referral hospitals in Addis Ababa, Ethiopia: A 3-month prospective study
Background: We sought to evaluate risk factors and outcomes for patients undergoing surgical treatment of acute limb ischemia (ALI) in Ethiopia.
Methods: We conducted a hospital-based prospective cohort study of consecutive patients undergoing surgical treatment for ALI at Tikur Anbessa Specialized Hospital (TASH) and Teklehaimanot General Hospitals in Addis Ababa, Ethiopia from January 1, 2018, to December 31, 2018. Diagnosis of ALI was made using a combination of clinical imaging by Doppler ultrasound or CT-angiography and intraoperative findings. Patients were followed up for 3 months postoperatively. Logistic regression modelling was conducted to assess the association of sociodemographic and clinical variables with amputation, postoperative complications, and mortality.
Results: Data were analysed on 102 of 116 patients who underwent a surgical procedure for ALI (mean age, 54 years; 67.6% male). Patients presented to hospital after an average of 9 days (range, 1-15 days) after symptom onset. The primary surgical procedures performed were thrombectomy (n=51, 47.2%), primary amputation (n=24, 22.2%), bypass or interposition vascular grafts (n=10, 9.2%), embolectomy (n=10, 9.2%), primary vascular repair (n=7, 6.4%), and femoro-femoral graft (n=6, 5.5%). Local and systemic complications occurred in 35.3% and 17.6%, respectively. Amputation after revascularization surgery was conducted in 33 (32.4%) patients. The 30-day rate of amputation and mortality rate were 52.9% and 9.8%, respectively. Variables significantly associated with complications like amputation or death were age greater than 60 years (P=0.017; OR, 3.8; 95% CI, 1.26-11.11), presentation greater than 9 days after symptom onset (P=0.013; OR, 4.22; 95% CI, 1.36-13.12), hypertension alone (P=0.031; OR, 2.76; 95% CI, 1.05-6.32), hypertension in combination with diabetes (P=0.028; OR, 10.15; 95% CI, 1.29-80.12), and other cardiac risk factors (P=0.036; OR, 5.31; 95% CI, 1.11-25.38).
Conclusions: High rates of amputation and postoperative complications occurred among patients surgically treated for ALI at 2 tertiary hospitals in Addis Ababa, Ethiopia. Timely detection of ALI and treatment of comorbidities are essential to improve outcomes in surgically treated ALI in this setting.