Critical Care & Pain Management, Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
Anaesthesia. 2014 Mar;69(3):249-58. doi: 10.1111/anae.12532.
Mortality after lower limb amputation is high, with UK 30-day mortality rates of 9-17%. We performed a retrospective analysis of factors affecting early and late outcome after lower limb amputation for peripheral vascular disease or diabetic complications at a UK tertiary referral vascular centre between 2003 and 2010. Three hundred and thirty-nine patients (233 male), of median (IQR [range]) age 73 (62-79 [26-92]) years underwent amputation. Thirty-day mortality was 12.4%. On regression modelling, the risk of 30-day mortality was increased in patients of ASA grade ≥ 4 (OR 4.23, 95% CI 2.07-8.63), p < 0.001 and age between 74 and 79 years (OR 3.8, 95% CI 1.10-13.13), p = 0.04 and older than 79 years (OR 4.08, 95% CI 1.25-13.25), p = 0.02. Peri-operative (30-day) mortality for these groups was 23.2%, 13.7% and 18.8%, respectively. Survival and Cox regression analysis demonstrated that long-term mortality was associated with: age 74-79 years (HR 2.15, 95% CI 1.38-3.35), p = 0.001; age > 79 years (HR 2.78, 95% CI 1.82-4.25), p < 0.001; ASA grade ≥ 4 (HR 2.04, 95% CI 1.51-2.75), p < 0.001; out-of-hours operating (HR 1.51, 95% CI 1.08-2.10), p = 0.02; and chronic kidney disease stage 4-5 (1.57, 95% CI 1.07-2.30), p = 0.02. Anaesthetic technique was associated with long-term mortality on survival analysis (p = 0.04), but not when analysed using regression modelling. Mortality after lower limb amputation relates to patient age, ASA, out-of-hours surgery and renal dysfunction. These data support lower limb amputations' being performed during daytime hours and after modification replace with 'of ' correctable risk factors.
下肢截肢后的死亡率很高，英国的 30 天死亡率为 9-17%。我们在英国的一家三级转诊血管中心对 2003 年至 2010 年间因外周血管疾病或糖尿病并发症进行下肢截肢的患者的早期和晚期结果的影响因素进行了回顾性分析。339 名患者（233 名男性）的中位（IQR [范围]）年龄为 73 岁（62-79 [26-92]）。30 天死亡率为 12.4%。在回归模型中，ASA 分级≥4 级（OR 4.23，95%CI 2.07-8.63）、p<0.001和 74-79 岁（OR 3.8，95%CI 1.10-13.13）、p=0.04 以及年龄大于 79 岁（OR 4.08，95%CI 1.25-13.25）、p=0.02 的患者发生 30 天死亡率的风险增加。这些组的围手术期（30 天）死亡率分别为 23.2%、13.7%和 18.8%。生存和 Cox 回归分析表明，长期死亡率与：74-79 岁年龄（HR 2.15，95%CI 1.38-3.35），p=0.001；年龄>79 岁（HR 2.78，95%CI 1.82-4.25），p<0.001；ASA 分级≥4 级（HR 2.04，95%CI 1.51-2.75），p<0.001；非工作时间手术（HR 1.51，95%CI 1.08-2.10），p=0.02；和慢性肾脏病 4-5 期（1.57，95%CI 1.07-2.30），p=0.02。在生存分析中，麻醉技术与长期死亡率相关（p=0.04），但在回归模型分析中不相关。下肢截肢后的死亡率与患者年龄、ASA、非工作时间手术和肾功能障碍有关。这些数据支持在白天和修改后的时间进行下肢截肢，以去除可纠正的危险因素。
