Discharge destination and one-year mortality in acute limb ischemia survivors after revascularization: A multicenter registry study.

Abstract

Acute limb ischemia may impair functional status and hinder return home after hospitalization, even in patients who survive to discharge. However, the associations among discharge destination, clinical characteristics, and outcomes have not been fully evaluated. Using a multicenter registry, we analyzed 769 patients with acute limb ischemia who underwent revascularization between July 2011 and March 2025 and survived to discharge. Nonhome discharge was defined as transfer to another hospital or nursing facility. Multivariable logistic regression incorporating baseline and procedural variables was performed to identify determinants of non-home discharge. One-year mortality after discharge was compared between the home and nonhome discharge groups. Nonhome discharge occurred in 287 patients (37.3%). Multivariable analysis demonstrated that advanced age, nonambulatory status, frailty, prior cerebrovascular disease, hypoalbuminemia, and receipt of public assistance were independently associated with nonhome discharge, as was severe ischemia (Rutherford category IIb/III). Procedural factors, including the need for surgical revascularization and inadequate distal perfusion (final Tibial Infrapopliteal Perfusion Index grade 0-1) were also associated with nonhome discharge. When stratified by cumulative risk burden (0-2, 3-5, ≥6 factors), the incidence of nonhome discharge increased stepwise (18%, 50%, and 92%, respectively; P < .001). One-year mortality was significantly higher among patients with nonhome discharge than among those discharged home (21.2% vs 7.6%; log-rank P < .001). More than one-third of patients with acute limb ischemia were unable to return home after revascularization. Discharge destination was independently associated with baseline vulnerability, disease severity, and procedural factors, and was linked to increased 1-year mortality.