Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX 79920, USA.
J Am Coll Surg. 2011 Sep;213(3):370-8. doi: 10.1016/j.jamcollsurg.2011.05.019. Epub 2011 Jul 1.
This investigation sought to evaluate risk factors for morbidity and mortality from a large series of below-knee amputees prospectively entered in a national database.
All patients undergoing below-knee amputations in the years 2005-2008 were identified in the database of the National Surgical Quality Improvement Program (NSQIP). Demographic data, medical comorbidities, and medical history were obtained. Mortality and postoperative complications within 30 days of the below-knee amputation were also documented. Chi-square test, univariate, and multivariate logistic regression analyses were used to assess the effect of specific risk factors on mortality, as well as the likelihood of developing major, minor, or any complications developing.
Below-knee amputations were performed in 2,911 patients registered in the NSQIP database between 2005 and 2008. The average age of patients was 65.8 years old and 64.3% were male. There was a 7.0% 30-day mortality rate and 1,627 complications occurred in 1,013 patients (34.4%). Multivariate logistic regression analysis identified renal insufficiency, cardiac issues, history of sepsis, steroid use, COPD, and increased patient age as independent predictors of mortality. The most common major complications were return to the operating room (15.6%), wound infection (9.3%), and postoperative sepsis (9.3%). History of sepsis, alcohol use, steroid use, cardiac issues, renal insufficiency, and contaminated/infected wounds were independent predictors of one or more complications developing.
Renal disease, cardiac issues, history of sepsis, steroid use, COPD, and increased patient age were identified as predictors of mortality after below-knee amputation. Renal disease, cardiac issues, history of sepsis, steroid use, contaminated/infected wounds, and alcohol use were also found to be predictors of postoperative complications.
本研究旨在通过前瞻性纳入国家数据库的大量小腿截肢患者，评估发病率和死亡率的风险因素。
在国家手术质量改进计划（NSQIP）数据库中确定了 2005-2008 年间接受小腿截肢的所有患者。获取了人口统计学数据、合并症和病史。还记录了小腿截肢后 30 天内的死亡率和术后并发症。使用卡方检验、单变量和多变量逻辑回归分析评估特定风险因素对死亡率的影响，以及发生主要、次要或任何并发症的可能性。
2005 年至 2008 年期间，NSQIP 数据库中登记了 2911 例小腿截肢患者。患者平均年龄为 65.8 岁，64.3%为男性。30 天死亡率为 7.0%，1013 例患者发生 1627 例并发症（34.4%）。多变量逻辑回归分析确定肾功能不全、心脏问题、脓毒症史、类固醇使用、COPD 和患者年龄增加是死亡的独立预测因素。最常见的主要并发症是返回手术室（15.6%）、伤口感染（9.3%）和术后脓毒症（9.3%）。脓毒症史、酒精使用、类固醇使用、心脏问题、肾功能不全和污染/感染伤口是发生一种或多种并发症的独立预测因素。
肾功能不全、心脏问题、脓毒症史、类固醇使用、COPD 和患者年龄增加被确定为小腿截肢后死亡的预测因素。肾功能不全、心脏问题、脓毒症史、类固醇使用、污染/感染伤口和酒精使用也被发现是术后并发症的预测因素。
