Sandnes Diana Kovacich, Sobel Michael, Flum David Reed
Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA.
J Am Coll Surg. 2004 Sep;199(3):394-402. doi: 10.1016/j.jamcollsurg.2004.05.270.
Lower extremity amputation has long been considered an end-of-life event and it is unclear if survival after amputation has improved over time.
A retrospective cohort comprised from a statewide, hospital discharge database was used to determine if survival after amputation improved with time. The cohort included all patients (older than 18 years) with nontraumatic, lower extremity amputations (1987 to 2000). Survival analysis was used to determine the adjusted hazard ratio of survival as it related to the era of amputation.
A total of 13,807 patients (mean age +/- SD, 67 +/- 15, 58.5% men) underwent amputation. The gender and age standardized frequency of amputation remained essentially stable, with a 0.01% increase per year (95% CI, 0.006-0.01%). During followup, 49.2% (6,795/13,807) of patients died, with significantly (p < 0.001) worse outcomes for more proximal levels of amputation. After controlling for potential confounders, including age, gender, level of amputation, comorbid illness, emergency status of procedure, hospital type, and payer of the procedure, patients undergoing amputation in more recent years (1995 to 2000) had a 28% lower hazard of dying (hazard ratio 0.72 [95% CI, 0.67-0.77%) during the study period than those undergoing operation before 1995. Thirty-day survival did not improve by era (p = 0.2), although 1- and 5-year survival after amputation was significantly greater for all levels of amputation (p < 0.001).
Although 30-day survival associated with amputation has remained stable in the state of Washington over the past 14 years, longterm survival after amputation has improved considerably with time. The reasons underlying this improvement should be explored so that further gains may be achieved.
下肢截肢长期以来一直被视为生命终结事件，目前尚不清楚截肢后的生存率是否随时间有所提高。
利用一个来自全州范围的医院出院数据库组成的回顾性队列，以确定截肢后的生存率是否随时间而提高。该队列包括所有（年龄大于18岁）非创伤性下肢截肢患者（1987年至2000年）。生存分析用于确定与截肢时代相关的生存调整风险比。
共有13807例患者（平均年龄±标准差，67±15岁，58.5%为男性）接受了截肢手术。截肢的性别和年龄标准化频率基本保持稳定，每年增加0.01%（95%可信区间，0.006 - 0.01%）。在随访期间，49.2%（6795/13807）的患者死亡，截肢部位越靠近近端，结局越差（p < 0.001）。在控制了包括年龄、性别、截肢水平、合并疾病、手术急诊状态、医院类型和手术支付方等潜在混杂因素后，近年来（1995年至2000年）接受截肢手术的患者在研究期间死亡风险比1995年前接受手术的患者低28%（风险比0.72 [95%可信区间，0.67 - 0.77%]）。30天生存率并未随时代改善（p = 0.2），尽管所有截肢水平的截肢后1年和5年生存率均显著提高（p < 0.001）。
尽管在过去14年里，华盛顿州与截肢相关的30天生存率保持稳定，但截肢后的长期生存率随时间有了显著提高。应探究这种改善的潜在原因，以便进一步提高生存率。
