The effect of congestive heart failure on perioperative outcomes in patients undergoing lower extremity revascularization Richard L. Amdur, PhD, Bernard.

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Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: Relationship Between Operator Volume and Adverse.

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The effect of congestive heart failure on perioperative outcomes in patients undergoing lower extremity revascularization Richard L. Amdur, PhD, Bernard Ashby, MD, MPP, Richard Neville, MD, Aundrea Tunstall, MD, Bao-Ngoc Nguyen, MD, Anton Sidawy, MD, MPH Journal of Vascular Surgery Volume 63, Issue 5, Pages 1289-1295 (May 2016) DOI: 10.1016/j.jvs.2015.11.039 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Confounds and mediators in the association of congestive heart failure (CHF) with outcomes. We are interested in estimating the effect of CHF on outcomes. This occurs through a direct causal path (A) and through the effect of CHF on mediating variables, which in turn have an effect on outcomes. The combined effect of CHF on outcomes through mediators is B × C. Confounding variables may increase the observed correlation of CHF with outcomes but do not represent a causal effect of CHF. Their combined effect equals D × E. The total observed correlation of CHF with outcomes is A + BC + DE. If we eliminate the effect of confounders using regression analysis, the adjusted effect of CHF on outcomes will be A + BC, or the direct plus mediated effects (ie, the total causal effect of CHF on outcomes). ASA, American Society of Anesthesiology; COPD, chronic obstructive pulmonary disease; CR, creatinine; CVA, cerebrovascular accident; DM, diabetes mellitus; EtOH, ethyl alcohol; HTN, hypertension; LOS, length of stay; MI, myocardial infarction; OR, operating room; PCI, percutaneous coronary intervention; PCS, previous cardiac surgery; TIA, transient ischemic attack. Journal of Vascular Surgery 2016 63, 1289-1295DOI: (10.1016/j.jvs.2015.11.039) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Perioperative outcomes for femoral-popliteal and femoral-distal bypass, by history of congestive heart failure (CHF). The error bars show the 95% confidence interval (CI). A, Graft patency. B, Pneumonia. C, Sepsis or septic shock. D, Thirty-day mortality. E, Return to operating room (OR). F, Postsurgery length of stay (LOS) >9 days. Journal of Vascular Surgery 2016 63, 1289-1295DOI: (10.1016/j.jvs.2015.11.039) Copyright © 2016 Society for Vascular Surgery Terms and Conditions