Factors affecting perioperative mortality and wound-related complications following major lower extremity amputations
Factors affecting perioperative mortality and wound-related complications following major lower extremity amputations
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DOI：
10.1007/s10016-006-9009-z
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发表时间：
2006-03-01
影响因子：
1.5
通讯作者：
Elmore, MS
中科院分区：
文献类型：
--
作者：
Stone, PA;Flaherty, SK;Elmore, MS
下肢大截肢术仍然与显著的发病率和死亡率相关，但最近很少有大型系列研究评价与围手术期死亡率和伤口并发症相关的因素。本研究的目的是探讨影响下肢大截肢围手术期死亡率和伤口相关并发症的因素。对西弗吉尼亚州南部一家三级护理中心5年内接受非创伤性下肢大截肢术的所有成年患者进行回顾性分析。收集并分析人口统计学和临床数据、围手术期数据和结局，以确定与围手术期死亡率以及伤口并发症和早期翻修（90天内）至更近端水平的任何关系。使用卡方检验、双尾t检验和逻辑回归检验变量。1999年至2003年间，380名患者（61%男性）接受了412例大下肢截肢手术。初始截肢水平包括230例膝下截肢（BKA），149例膝上截肢（AKA）和1例髋关节离断。围手术期死亡率为15.5%（n = 59）。从回归模型来看，年龄、白蛋白水平、AKA和既往无冠状动脉旁路移植术（CABG）与死亡率独立相关。没有接受过冠状动脉旁路移植术的患者死亡的可能性是接受过冠状动脉旁路移植术的患者的近3倍（p = 0.038）。13.4%（n = 51）观察到总体早期伤口并发症。四个因素与90天伤口并发症的发生独立相关：BKA、社区（而不是护理机构）生活、麻醉类型和术前红细胞压积> 30%。周围血管疾病患者的下肢大截肢术仍然与相当大的围手术期发病率和死亡率相关。尽管从技术角度来看，外科手术本身可能没有挑战性，但潜在的医疗条件使这一群体面临围手术期死亡的高风险。伤口愈合问题经常遇到，必须尽量减少，以促进早期动员和出院。
Major lower extremity amputations continue to be associated with significant morbidity and mortality, yet few recent large series have evaluated factors associated with perioperative mortality and wound complications. The purpose of this study was to examine factors affecting perioperative mortality and wound-related complications following major lower extremity amputation. A retrospective review was conducted of all adult patients who underwent nontraumatic major lower extremity amputations over a 5-year period at a single tertiary-care center in southern West Virginia. Demographic and clinical data, perioperative data, and outcomes were collected and analyzed to identify any relationship with perioperative mortality, as well as wound complications and early revisions (within 90 days) to a more proximal level. Variables were examined using chi-squared, two-tailed t-tests, and logistic regression. Three hundred eighty patients (61% male) underwent 412 major lower extremity amputations during 1999-2003. The initial level of amputation included 230 below-knee (BKA), 149 above-knee (AKA), and one hip disarticulation. Perioperative mortality was 15.5% (n = 59). From a regression model, age, albumin level, AKA, and lack of a previous coronary artery bypass graft (CABG) were independently related to mortality. Patients who did not have a previous CABG were nearly three times more likely to die than those who did (p = 0.038). Overall early wound complications were noted in 13.4% (n = 51). Four factors were independently related to experiencing a 90-day wound complication: BKA, community (rather than care facility) living, type of anesthesia, and preoperative hematocrit > 30%. Major lower extremity amputation in patients with peripheral vascular disease continues to be associated with considerable perioperative morbidity and mortality. Even though the surgical procedure itself may not be challenging from a technical standpoint, underlying medical conditions put this group at high risk for perioperative death. Wound-healing problems are frequently encountered and must be minimized to facilitate early mobilization and hospital discharge.