Kelly David A, Pedersen Stephanie, Tosenovsky Patrik, Sieunarine Kishore
Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
Ann Vasc Surg. 2017 Nov;45:29-34. doi: 10.1016/j.avsg.2017.05.039. Epub 2017 Jun 8.
Outcomes following major lower limb amputation (MLLA) between 2000 and 2002 from the Department of Vascular Surgery at Royal Perth Hospital have been published; mean postoperative length of stay 20 days, inpatient complication rate 54%, and 30-day mortality 10%. The last decade has seen increasing endovascular revascularization techniques, increased focus on MLLA patients, and general improvements in the model of care. The aim of this study is to compare outcomes between 2000-2002 and 2010-2012.
Data on all patients undergoing MLLA, transtibial or proximal, in the 2 time periods were extracted from the department of vascular surgery database. Medical records, government registries, and phone calls to primary care providers were used to clarify mortality.
Limb ischemia remains the most common indication for MLLA with smoking, hypertension, and diabetes being the main comorbid diseases. The rates of wound infections have fallen from 26.4% to 12.4% (P = 0.023), rate of admission to ICU has fallen from 48.3% to 17.5% (P = 0.001), and revision amputation to a higher level has fallen from 11.5% to 7.2% (P = 0.043). Acute hospital, postoperative length of stay has trended down from 15.74 to 20.29 days (P = 0.075). Mortality overall has fallen from 60.92% to 46.39% (P = 0.049). Thirty-day mortality fallen from 10.34% to 5.15% (P = 0.185), 6-month 28.76% to 16.5% (P = 0.046), and 1-year 40.22% to 21.65% (P = 0.006).
Patients undergoing MLLA still carry a high burden of comorbid disease. With changes in revascularization technique, consultant supervision, and multidisciplinary model of care, we have seen the rate of complications fall, length of stay trend down, and overall mortality reduce. Despite improvements, outcomes remain sobering and more can be done.
珀斯皇家医院血管外科已公布2000年至2002年期间大下肢截肢（MLLA）后的结果；术后平均住院时间为20天，住院并发症发生率为54%，30天死亡率为10%。在过去十年中，血管内血运重建技术不断增加，对MLLA患者的关注增多，护理模式也普遍得到改善。本研究的目的是比较2000 - 2002年和2010 - 2012年期间的结果。
从血管外科数据库中提取两个时间段内所有接受MLLA（经胫骨或近端）患者的数据。使用病历、政府登记处信息以及与初级保健提供者的电话沟通来明确死亡率。
肢体缺血仍然是MLLA最常见的指征，吸烟、高血压和糖尿病是主要的合并症。伤口感染率从26.4%降至12.4%（P = 0.023），入住重症监护病房（ICU）率从48.3%降至17.5%（P = 0.001），更高水平的再次截肢率从11.5%降至7.2%（P = 0.043）。急性住院术后住院时间从15.74天降至20.29天（P = 0.075）。总体死亡率从60.92%降至46.39%（P = 0.049）。30天死亡率从10.34%降至5.15%（P = 0.185），6个月时从28.76%降至16.5%（P = 0.046），1年时从40.22%降至21.65%（P = 0.006）。
接受MLLA的患者仍伴有高负担的合并症。随着血运重建技术、顾问监督和多学科护理模式的改变，我们看到并发症发生率下降，住院时间呈下降趋势，总体死亡率降低。尽管有所改善，但结果仍然不容乐观，仍有更多工作可做。
