O'Hare Ann M, Feinglass Joe, Reiber Gayle E, Rodriguez Rudolph A, Daley Jennifer, Khuri Shukri, Henderson William G, Johansen Kirsten L
Department of Medicine, San Francisco VAMC, San Francisco, California 94121, USA. ann.o'
J Am Soc Nephrol. 2004 Feb;15(2):427-34. doi: 10.1097/01.asn.0000105992.18297.63.
Mortality rates after lower extremity amputation are extremely high among dialysis patients. However, the impact of milder degrees of renal insufficiency on death rates after lower extremity amputation has not been carefully examined. In this study, the authors used data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to measure the association between renal dysfunction and 30-d mortality after nontraumatic amputation adjusted for confounders. The study population consisted of 16,994 patients undergoing their first NSQIP recorded amputation from January 1, 1994 through September 30, 2001. Thirty-five percent of all cohort patients had at least moderate renal insufficiency, and 52% of all postoperative deaths occurred in this group. Postoperative mortality was 9% in patients with moderate renal insufficiency, 15% in patients with severe renal insufficiency, and 16% in dialysis patients, compared with 6% in patients with normal or mildly reduced renal function. Renal insufficiency remained associated with death after adjustment for confounders (adjusted odds ratio [OR] 3.36, 95% confidence interval [CI] 2.75 to 4.10 [dialysis patients]; OR 2.54, CI 2.06 to 3.14 [severe renal insufficiency]; and OR 1.52, CI 1.32 to 1.76 [moderate renal insufficiency]). In conclusion, even moderate renal insufficiency is independently associated with postoperative death after lower extremity amputation. This finding highlights the need for a targeted approach to improving the care of patients with renal insufficiency undergoing lower extremity amputation.
在透析患者中，下肢截肢后的死亡率极高。然而，轻度肾功能不全对下肢截肢后死亡率的影响尚未得到仔细研究。在本研究中，作者使用了退伍军人事务部国家外科质量改进计划（NSQIP）的数据，以测量肾功能障碍与非创伤性截肢后30天死亡率之间的关联，并对混杂因素进行了调整。研究人群包括1994年1月1日至2001年9月30日期间首次接受NSQIP记录的截肢手术的16994例患者。所有队列患者中35%至少有中度肾功能不全，所有术后死亡患者中有52%发生在该组。中度肾功能不全患者的术后死亡率为9%，重度肾功能不全患者为15%，透析患者为16%，而肾功能正常或轻度降低的患者为6%。在对混杂因素进行调整后，肾功能不全仍然与死亡相关（调整后的优势比[OR]为3.36，95%置信区间[CI]为2.75至4.10[透析患者]；OR为2.54，CI为2.06至3.14[重度肾功能不全]；OR为1.52，CI为1.32至1.76[中度肾功能不全]）。总之，即使是中度肾功能不全也与下肢截肢术后死亡独立相关。这一发现凸显了需要采取有针对性的方法来改善接受下肢截肢手术的肾功能不全患者的护理。
