Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
Surgery. 2012 Oct;152(4):685-94; discussion 694-6. doi: 10.1016/j.surg.2012.07.017.
The objective was to develop a preoperative mortality risk stratification tool for patients facing major amputation.
Patients who underwent above-knee (AKA) or below-knee amputation (BKA) from 2005 to 2010 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Univariate and multivariate analyses were performed to determine the association of preoperative factors with 30-day mortality. Multivariable models were used to create a computerized prediction tool.
Of 9,368 patients, 4,032 underwent AKA and 5,336 BKA. The 30-day mortality rate after AKA was 12.8%, almost double that of BKA (6.5%, P < .001). The complication rate was statistically greater after AKA although numerically similar (28.5% vs 26.6%, P = .020), whereas the rate of reoperation was substantially greater after BKA (22.7% vs 11.7%, P < .001). Preoperative factors that predicted mortality after both procedures included older age, dependent functional status, dialysis, steroid use, preoperative sepsis, delirium, thrombocytopenia, increased international normalized ratio, and azotemia. Prediction tools were developed and validated, and their concordance indices were 0.75 for AKA and 0.81 for BKA, indicating good predictive accuracy.
Preoperative factors predict mortality after major amputation, and the risk calculator that we have developed may facilitate informed decision-making and provide realistic expectations for surgeons and patients faced with limb-threatening disease.
本研究旨在为面临主要截肢的患者开发一种术前死亡率风险分层工具。
从美国外科医师学会国家手术质量改进计划（ACS NSQIP）数据库中确定了 2005 年至 2010 年间接受膝上（AKA）或膝下（BKA）截肢的患者。进行单变量和多变量分析以确定术前因素与 30 天死亡率的关联。使用多变量模型创建计算机预测工具。
在 9368 例患者中，4032 例行 AKA，5336 例行 BKA。AKA 后的 30 天死亡率为 12.8%，几乎是 BKA 的两倍（6.5%，P<0.001）。尽管数值相似，但 AKA 后的并发症发生率更高（28.5%对 26.6%，P=0.020），而 BKA 后的再次手术率则明显更高（22.7%对 11.7%，P<0.001）。两种手术术后预测死亡率的术前因素均包括年龄较大、依赖功能状态、透析、使用类固醇、术前败血症、谵妄、血小板减少症、国际标准化比值升高和氮血症。开发并验证了预测工具，其 AKAs 的一致性指数为 0.75，BKA 的一致性指数为 0.81，表明具有良好的预测准确性。
术前因素可预测主要截肢后的死亡率，我们开发的风险计算器可促进知情决策，并为面临肢体威胁性疾病的外科医生和患者提供现实的预期。
