Health-related quality of life and functional outcome following arterial reconstruction for limb salvage

Vascular surgery outcomes have traditionally been measured by limb salvage and graft patency, However, as health care resources are rationed, the pati ent's functional outcome and quality of life will require assessment. The i n situ saphenous vein graft has proven successful in achieving long-term li mb salvage for patients with critical ischemia, with the expectation of pre serving a life-style and sense of well-being that would be lost with limb a mputation. This study was conducted to measure functional capacity and qual ity of life in these patients. Seventy patients with successful in situ sap henous vein bypass grafts constructed for limb-threatening ischemia, follow ed for a mean of 45.6 months in a surveillance program with normal graft fl ow characteristics, were compared with a group of age and gender-matched co ntrols with normal limb pressures and no history of vascular occlusive dise ase, A questionnaire was designed from standardized health status scales an d administered to the two groups to assess symptoms, health perceptions, ph ysical functioning and life quality. When comparing the groups of revascula rized and control patients, symptoms and perceptions about their health wer e similar. However, the revascularized patients had significantly decreased functional capacity in their ability to walk various distances (P less tha n or equal to 0.005), perform household tasks (P less than or equal to 0.00 1) and bathe (P less than or equal to 0.001). The patient group with vascul ar grafts functioned as well as the controls only in activities of dressing and using the toilet, Indicators of life quality that rate independence an d mobility, including the ability to procure groceries (P less than or equa l to 0.001), prepare meals (P less than or equal to 0.005) participate in s ocial activities (P less than or equal to 0.001) and drive an automobile (P less than or equal to 0.01), were also significantly limited in the patien ts with successful vascular reconstructions. Although achieving long-term l imb salvage and graft patency, the patients in this group of successful vas cular reconstructions retain functional disabilities that require significa nt care. Despite these physical handicaps, these patients have a remarkably similar sense of well-being and lack of somatic complaints compared with t he control group, This medical outcome study identifies the functional capa city and lifetime needs for vascular surgery patients that will provide use ful data for those responsible for allocating health care resources. (C) 19 99 The International Society for Cardiovascular Surgery, Published by Elsev ier Science Ltd. Ail rights reserved.