LAUSR

Objectives: In 2009, the Society for Vascular Surgery (SVS) developed objective performance goals (OPGs) to define the therapeutic benchmarks for catheter-based revascularization in critical limb ischemia (CLI) based upon outcomes from randomized trials of lower extremity bypass (SVS OPG cohort). Current real-world performance relative to these benchmarks remains unknown. The objective of this study was to determine whether lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) performed for CLI in a contemporary national cohort met OPG safety benchmarks. Methods: SVS OPG criteria were applied to 11,043 revascularizations for CLI performed from 2011 to 2015 in the National Surgical Quality Improvement Project (NSQIP) vascular-targeted modules. Primary 30-day safety OPGs, including major adverse cardiac events (MACE), major adverse limb events (MALE), and amputation, were calculated for all OPG-eligible NSQIP LEB (bypass with single-segment saphenous vein, n 1⁄4 3,835; Table I) and IEI (defined as angioplasty, stenting, and/or atherectomy, n 1⁄4 3,526; Table I) cohorts and within anatomic high-risk (infrapopliteal disease) and clinical high-risk (age >80 and tissue loss) cohorts defined by SVS OPG criteria. These were compared with SVS OPGs using c comparisons. Results: Compared with the SVS OPG cohort, the NSQIP LEB and IEI cohorts had fewer anatomic high-risk patients (LEB: 51% vs SVS OPG 60%; P < .0001; IEI: 17% vs SVS OPG: 60%; P < .0001), and the LEB cohort had fewer clinical high-risk patients (LEB: 11% vs SVS OPG: 16%; P < .0001). In the OPG-eligible NSQIP cohorts, LEB and IEI were associated with lower 30-day MACE but higher 30-day MALE and amputation compared