Impact of Rural Status on Lower Extremity Bypass Outcomes for Patients With Chronic Limb Threatening Ischemia

Background: Previous studies noted that the rural population experienced higher peripheral artery disease related mortality than their urban counterparts. Our study aimed to assess the impact of rural status on lower extremity bypass (LEB) outcomes for patients with chronic limb threatening ischemia. Methods: We analyzed data from the Blue Cross Blue Shield Michigan Cardiovascular Consortium registry data from 2016 to 2022. Primary exposure included patient's residence based on rural-urban commuting area codes. Primary outcome was major adverse cardiovascular events. Secondary outcomes include 30-day and 1-year mortality, hospital readmission, bypass revision, wound complications, amputations, and 30-day renal failure requiring dialysis. We conducted univariate and multivariate analysis to evaluate association between rural status and LEB outcomes. Results: Rural patients tended to be White (P < 0.001), had insurance (P < 0.001), were current smokers (P < 0.001), had hyperlipidemia (P < 0.001), prior congestive heart failure (P = 0.031), chronic obstructive pulmonary disease (P < 0.001), prior cerebrovascular disease or transient ischemic attack (P = 0.005), take preprocedure aspirin (P = 0.011) and statin (P = 0.007), and were less likely to live in a distressed community (P < 0.001). They were not at increased risks of 30-day and 1-year major adverse cardiovascular events. They had higher odds of bypass revision (P = 0.028) at 1 year. However, they did not have higher odds of amputation at 30 days and 1 year. Conclusion: Rural status does not impact LEB outcomes. Rural patients achieve comparable outcomes compared with their urban counterparts due to overwhelmingly White rural demographics, optimal medical therapy, socioeconomic status, and increased health-care utilization.