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 procedures for treatment of acute limb ischaemia (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 and Teklehaimanot General Hospital in Addis Ababa, Ethiopia from 1 January through 31 December 2018. ALI diagnoses were made using Doppler ultrasound or computed tomography angiography and intraoperative findings. Patients were followed for 3 months postoperatively. Logistic regression modelling was conducted to assess the associations of sociodemographic and clinical variables with amputation, postoperative complications, and mortality.
Results: Data were analysed for 102 of 116 patients who underwent surgical procedures 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 femorofemoral 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 patients (32.4%). The 30-day amputation and mortality rates were 52.9% and 9.8%, respectively. Variables significantly associated with complications (such as amputation) or death were age greater than 60 years (OR, 3.8; 95% CI, 1.3-11.1; P=0.02), presentation later than 9 days after symptom onset (OR, 4.2; 95% CI, 1.4-13.1; P=0.01), hypertension alone (OR, 2.8; 95% CI, 1.1-6.3; P=0.03), hypertension in combination with diabetes mellitus (OR, 10.2; 95% CI, 1.3-80.1; P=0.03), and other cardiac risk factors (OR, 5.3; 95% CI, 1.1-25.4; P=0.04).
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 for improving outcomes for patients with surgically treated ALI in this setting.