Clinical and Socioeconomic Predictors of Outcomes in Patients With Lower Extremity Vascular Trauma Requiring Operative Management.

BACKGROUND: Lower extremity vascular trauma (LEVT) carries a significant risk of limb loss and mortality. The influence of socioeconomic factors on outcomes remains less well defined. This study evaluated injury patterns and predictors of adverse outcomes among patients undergoing operative management for LEVT. METHODS: A retrospective review was performed of adults (>15 years) undergoing surgical intervention for LEVT between January 2011 and December 2022. Demographic, clinical, and neighborhood socioeconomic data were analyzed. Multivariable Firth regression identified predictors of mortality and surgical amputation. Geographic clustering of injury patterns was assessed using Moran's I. RESULTS: Among 235 patients, 65.1% sustained penetrating injuries and 34.9% blunt injuries. Blunt trauma patients were older, had longer time to intervention (77 vs 45 minutes, p<0.001), higher fracture rates (72% vs 37%, p<0.001), and longer hospital length of stay (17 vs 9 days, p<0.001). Overall, 20% patients underwent traumatic (n=31) or surgical amputation (n=16), with higher rates following blunt trauma (52% vs 3%, p<0.001). Overall mortality was 8.9%. Mortality was independently associated with older age, higher Injury Severity Score, and lower Glasgow Coma Scale score, with an exploratory association observed for greater neighborhood poverty. No significant geographic clustering of injury mechanism was observed. CONCLUSION: In LEVT requiring operative management, blunt mechanism is associated with delayed intervention and increased limb loss, while mortality is primarily associated with injury severity. Neighborhood poverty demonstrated an exploratory association with mortality.