This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Vascular patients receiving infrainguinal bypass procedures may have poor outcomes related to existing pre-operative or post-operative physiological and psychological conditions. The purpose of this study is to identify physiological and psychological factors that predict 30 and 90-day post-operative outcomes for patients who receive lower extremity revascularization surgery (these time points mark the end of the operative period and release back to full activity when the patient does well). A prospective repeated-measures design will be used to investigate this Dissertation Committee approved study with three specific aims: 1) To determine the associations among a measure of inflammation (serum C-reactive protein), a measure of chronic physiological stress response (salivary cortisol), measures of psychological mood (anxiety and depression), and health-related quality of life in subjects with peripheral arterial disease prior to revascularization surgery; 2) To determine and compare measures of C-reactive protein, salivary cortisol, anxiety, depression, and health-related quality of life at three time points (pre-operative, 30 and 90-days post-operative) in a group of peripheral arterial disease revascularization surgery subjects; and 3) To determine which pre-operative variables (C-reactive protein, salivary cortisol, anxiety, depression or health-related quality of life) have predictive power for post-operative outcomes after controlling for selected subject characteristics, comorbidities (Charlson Comorbidity Index) and pre-operative peripheral artery disease severity (ankle-brachial index). Outcomes include hospital length of stay (initial and readmission), change in ankle-brachial index, surgical incision healing, morbidity (Surgical Morbidity Score) and mortality at 30 and 90 days post-operatively. A sample size of 75 will be recruited to meet the most rigorous power requirements in the regression analysis of specific aim 3.
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