Identifying the Incidence of and Risk Factors for Reamputation Among Patients Who Underwent Foot Amputation
Identifying the Incidence of and Risk Factors for Reamputation Among Patients Who Underwent Foot Amputation
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DOI：
10.1016/j.avsg.2012.02.011
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发表时间：
2012-11-01
影响因子：
1.5
通讯作者：
Muder, Robert R.
中科院分区：
文献类型：
--
作者：
Kono, Yuriko;Muder, Robert R.
背景：许多下肢截肢患者继发于周围血管疾病或糖尿病，最终需要截肢。本研究旨在确定前足截肢后同侧再截肢的发生率和风险因素，评估术后感染是否会增加再截肢的风险，并评估截肢后抗菌治疗的持续时间是否会降低再截肢的风险。方法：回顾性分析了2002年1月至2004年12月在匹兹堡退伍军人事务部医疗保健系统因非创伤性原因进行足部截肢的患者。在116例患者中，57例（49.1%）在首次手术后3年内进行了同侧截肢; 78.9%在前6个月内接受了截肢; 53例（45.7%）在3年内死亡; 16例（13.8%）发生了术后感染。单因素分析显示，截肢节段高、住院时间长、胰岛素依赖型糖尿病和入院时体格检查发现坏疽是再次截肢的危险因素。坏疽（比值比：多因素分析显示，胰岛素依赖型糖尿病（OR：2.93，95%可信区间：1.26-6.78，P = 0.012）是冠心病的危险因素。术后感染不会增加再次截肢的风险。截肢后使用抗生素超过2周的疗程并不能阻止reamputation.Conclusions：大约有一半的患者需要同侧截肢，并在3年内死亡。入院时坏疽和胰岛素依赖型糖尿病史是显著的危险因素（P = 0.003，P = 0.028）。截肢术后长时间使用抗生素和术后感染不会改变再次截肢的风险。
Background: Many patients who have lower-extremity amputations secondary to peripheral vascular disease or diabetes require reamputation eventually. This study was designed to identify the incidence of and risk factors for ipsilateral reamputation after forefoot amputation, to evaluate whether postoperative infection increases the risk of reamputation, and to evaluate whether the risk of reamputation was reduced by the duration of antimicrobial therapy after amputation.Methods: A retrospective analysis of patients who underwent foot amputation for nontraumatic reason from January 2002 to December 2004 at the Veterans Affairs Pittsburgh Healthcare System was performed.Results: Among 116 patients, 57(49.1%) had ipsilateral reamputation within 3 years after their first surgeries; 78.9% received reamputation in the first 6 months; 53 (45.7%) died within 3 years; and 16 (13.8%) developed postoperative infections. Upper level of amputation, long duration of hospitalization, insulin-dependent diabetes, and gangrene on physical examination on admission were risk factors for reamputation in univariate analysis. Gangrene (odds ratio: 3.81, 95% confidence interval: 1.60-9.12, P = 0.003) and insulin-dependent diabetes (odds ratio: 2.93, 95% confidence interval: 1.26-6.78, P = 0.012) were risk factors in multivariate analysis. Postoperative infection did not increase the risk of reamputation. Longer than 2-week course of antibiotic use after amputation did not prevent reamputation.Conclusions: Approximately one-half of patients required ipsilateral reamputation and died in 3 years. Gangrene on admission and history of insulin-dependent diabetes were significant risk factors (P = 0.003, P = 0.028). Long duration of antibiotic use after amputation and postoperative infection did not change the risk of reamputation.