Outcomes of prophylactic fasciotomy in patients with non-traumatic acute limb ischemia

Abstract

ObjectivesPost-reperfusion compartment syndrome is an emergency consequence following revascularization of acute limb ischemia. Fasciotomy is the gold standard treatment for acute compartment syndrome. Some surgeons perform prophylactic fasciotomy (PF) during the same operation; however, fasciotomy may lead to wound complications and an increased length of hospital stay. This study aims to evaluate the outcomes of prophylactic fasciotomy in our hospital.MethodsThis is a retrospective observational cohort study. We reviewed the data of acute limb ischemia patients at Maharaj Nakorn Chiangmai Hospital, who were diagnosed with non-traumatic acute limb ischemia and received revascularization between January 2006 and August 2022. The primary outcomes are 30-day amputation-free survival (AFS) and overall survival (OS). Propensity score weighting with confounder adjustment was used to balance peri-operative confounders.ResultsFrom our data, there were 56 patients in the PF group and 301 in the non-prophylactic fasciotomy (NPF) group. The 30-day amputation rates were 12.5% and 10% in the PF and NPF groups, respectively (p-value 0.895). The 30-day AFS was similar between the PF and NPF groups, with a hazard ratio (HR) of 0.93, 95% confidence interval (CI) 0.32-2.45, and a p-value of 0.882. The 30-day OS in the PF group was statistically lower than that in the NPF group, HR 4.09, 95% CI 1.55-10.77, and a p-value of 0.004. The 1-year and 5-year AFS were not significantly different between the PF and NPF groups. However, the 1-year and 5-year OS were lower in the PF group compared to the NPF group, with HR 3.44, 95% CI 1.37-8.65, and a p-value of 0.009, and HR 3.04, 95% CI 1.24-7.45, and a p-value of 0.015, respectively. Fasciotomy wound infection rates were higher in the PF group compared to the NPF group, 5.5% versus 1.7%, respectively, p-value 0.017. Other clinical outcomes did not show significant statistical differences.ConclusionsProphylactic fasciotomy may not improve amputation-free survival (AFS) but increases mortality, particularly within the first 30 days, even in some high-risk patients. The use of prophylactic fasciotomy should be limited to cases where it is clearly indicated.

Keywords: Compartment syndrome; acute limb ischemia; ischemia-reperfusion injury; post-reperfusion compartment syndrome; prophylactic fasciotomy; reperfusion syndrome.