Major lower extremity amputations at a Veterans Affairs hospital
Major lower extremity amputations at a Veterans Affairs hospital
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DOI：
10.1016/j.amjsurg.2003.07.027
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发表时间：
2003-11-01
影响因子：
3
通讯作者：
Moursi, MM
中科院分区：
文献类型：
--
作者：
Cruz, CP;Eidt, JF;Moursi, MM
背景：本研究旨在评估退伍军人事务部（VA）医院7年来连续下肢大截肢的经验。方法：回顾性分析1994年9月至2001年10月86个月期间，229例患者（男221例，女8例）连续行296例下肢大截肢（膝上截肢119例，膝下截肢177例）的资料。所有截肢手术均由血管外科成员进行。结果：229例患者中有40例（17%）最终需要对侧截肢，27例（12%）患者有bka，最终需要转换为AKA， 44例（15%）截肢患者需要初始断头台截肢。BKA、AKA和BKA至AKA手术的30天死亡率分别为12%、17%和7%。88例截肢患者（30%）出现伤口并发症，需要137次手术修复。77例截肢患者（26%）先前接受过血运重建术，其中31例（48%）早期旁路手术失败。术前踝关节/肱指数（ABI）平均为0.57。在接受截肢手术的患者中，97例（42%）主诉静息痛，91例（40%）主诉跛行，158例（69%）在手术时发生组织丢失或坏疽。146例（64%）为糖尿病。22名患者（9%）依赖透析，81名患者（35%）承认吸烟。在已知的死亡原因中，21例死于心肌梗死，22例死于充血性心力衰竭，14例死于呼吸衰竭，13例死于弥散性癌症，10例死于败血症，7例死于中风，6例死于肾衰竭。术前功能状态测定显示272例患者有足够的信息来评估功能状态，43例完全依赖，97例部分独立，132例独立。在229例患者中，168例（73%）在截肢前可以走动，而在本综述完成时，只有53例（23%）可以走动。结论：大多数下肢大截肢患者存在多种合并症；因此，发病率和死亡率很高，最常见的死亡原因是心脏和呼吸系统疾病。这些数据表明，下肢主要截肢是高危人群，7年生存率仅为39%，住院时间延长（平均15天，范围3至105天），除了与功能状态下降相关的巨大费用外，还需要付出高昂的代价。(C) 2003年摘录医药股份有限公司版权所有。
Background: This study was made to evaluate the experience at a Department of Veterans Affairs (VA) hospital with consecutive major lower extremity amputations over a period of 7 years.Methods: The records of 229 patients (221 male and 8 female) who underwent 296 consecutive major lower extremity amputations (119 above-knee amputations [AKA] and 177 below-knee amputations [BKA]) over a period of 86 months (September 1994 to October 2001) were retrospectively analyzed. All amputations were performed by, members of the vascular surgery department.Results: Forty of the 229 patients (17%) eventually required a contralateral amputation, 27 patients (12%) had BKAs that eventually necessitated conversion to AKA, and 44 amputations (15%) required an initial guillotine amputation. The 30-day mortalities for BKA, AKA, and BKA to AKA operations were 12%, 17%, and 7%, respectively. Eighty-eight of the amputations (30%) developed wound complications, and required 137 revisions. Seventy-seven of the amputations (26%) had undergone prior revascularization, of which 31 (48%) had an early failed bypass. The average preoperative ankle/brachial index (ABI) was 0.57. Of the patients undergoing amputation, 97 (42%) complained of rest pain, 91 (40%) complained of claudication, and 158 (69%) had tissue loss or gangrene at the time of their operation. One hundred and forty-six patients (64%) were diabetic. Twenty-two patients (9%) were dialysis dependent and 81 patients (35%) admitted to smoking. Of the known causes of death, 21 resulted from myocardial infarction, 22 from congestive heart failure, 14 from respiratory failure, 13 from disseminated cancer, 10 from sepsis, 7 from stroke, and 6 from renal failure. Preoperative functional status determinations revealed that of 272 patients with enough information to assess functional status, 43 were totally dependent, 97 were partially independent, and 132 were independent. Of the 229 patients, 168 (73%) were ambulatory prior to their amputation, and at the completion of this review only 53 patients (23%) were ambulatory.Conclusions: Most patients undergoing major lower extremity amputations have many comorbidities; hence morbidity and mortality rates are high, with the most common causes of death being cardiac and respiratory in nature. These data suggest that major lower extremity amputations highlight a very high-risk population with only 39% survival at 7 years, as well as a costly subset secondary to prolonged hospitalization times (average 15 days, range 3 to 105), in addition to the extraordinary cost associated with diminished functional status. (C) 2003 Excerpta Medica, Inc. All rights reserved.