Morisaki Koichi, Yamaoka Terutoshi, Iwasa Kazuomi
Department of Vascular Surgery, Matsuyama Red Cross Hospital, Japan.
Vascular. 2018 Feb;26(1):12-17. doi: 10.1177/1708538117714197. Epub 2017 Jun 6.
Purpose Risk factors for wound complications or 30-day mortality after major amputation in patients with peripheral arterial disease remain unclear. We investigated the outcomes of major amputation in patients with peripheral arterial disease. Methods Patients who underwent major amputation from 2008 to 2015 were retrospectively analyzed. The main outcome measures were risk factors for wound complications and 30-day mortality after major lower limb amputations. Major amputation was defined as above-knee amputation or below-knee amputation. Wound complications were defined as surgical site infection or wound dehiscence. Results In total, 106 consecutive patients underwent major amputation. The average age was 77.3 ± 11.2 years, 67.9% of patients had diabetes mellitus and 35.8% were undergoing hemodialysis. Patients who underwent primary amputation constituted 61.9% of the cohort, and the proportions of above-knee amputation and below-knee amputation were 66.9% and 33.1%, respectively. The wound complication rate was 13.3% overall, 10.3% in above-knee amputation, and 19.5% in below-knee amputation. Multivariate analysis showed that the risk factors for wound complications were female sex (hazard ratio, 4.66; 95% confidence interval, 1.40-17.3; P = 0.01) and below-knee amputation (hazard ratio, 4.36; 95% confidence interval, 1.20-17.6; P = 0.03). The 30-day mortality rate was 7.6%, pneumonia comprised the most frequent cause of 30-day mortality, followed by sepsis and cardiac death. Multivariate analysis showed that a low serum albumin concentration (hazard ratio, 3.87; 95% confidence interval, 1.12-16.3; P = 0.03) was a risk factor for 30-day mortality. Conclusions Female sex and below-knee amputation were risk factors for wound complications. A low serum albumin concentration was a risk factor for 30-day mortality after major amputation in Japanese patients with peripheral arterial disease.
目的 外周动脉疾病患者接受大截肢术后伤口并发症或30天死亡率的危险因素仍不明确。我们调查了外周动脉疾病患者大截肢的结局。方法 对2008年至2015年接受大截肢手术的患者进行回顾性分析。主要结局指标为下肢大截肢术后伤口并发症的危险因素和30天死亡率。大截肢定义为膝上截肢或膝下截肢。伤口并发症定义为手术部位感染或伤口裂开。结果 共有106例连续患者接受了大截肢手术。平均年龄为77.3±11.2岁，67.9%的患者患有糖尿病，35.8%的患者正在接受血液透析。接受初次截肢的患者占队列的61.9%，膝上截肢和膝下截肢的比例分别为66.9%和33.1%。总体伤口并发症发生率为13.3%，膝上截肢为10.3%，膝下截肢为19.5%。多因素分析显示，伤口并发症的危险因素为女性（风险比，4.66；95%置信区间，1.40 - 17.3；P = 0.01）和膝下截肢（风险比，4.36；95%置信区间，1.20 - 17.6；P = 0.03）。30天死亡率为7.6%，肺炎是30天死亡的最常见原因，其次是败血症和心源性死亡。多因素分析显示，低血清白蛋白浓度（风险比，3.87；95%置信区间，1.12 - 16.3；P = 0.03）是30天死亡率的危险因素。结论 女性和膝下截肢是伤口并发症的危险因素。低血清白蛋白浓度是日本外周动脉疾病患者大截肢术后30天死亡率的危险因素。
