Vogel Todd R, Smith Jamie B, Kruse Robin L
Department of Surgery, Division of Vascular Surgery, University of Missouri Hospital & Clinics, One Hospital Drive, Columbia, MO 65212(∗).
Department of Family and Community Medicine, University of Missouri, School of Medicine, Columbia, MO(†).
PM R. 2018 Dec;10(12):1321-1329. doi: 10.1016/j.pmrj.2018.05.017. Epub 2018 May 29.
Understanding risk factors associated with readmission after lower extremity amputation may indicate targets for reducing readmission.
To evaluate factors associated with all-cause 30-day readmission after lower extremity amputation procedures.
Retrospective cohort study.
Inpatient.
A total of 2480 patients who had lower extremity amputations between 2008 and 2014 were selected from national electronic medical record database, Cerner Health Facts.
Univariate analysis of demographics, diagnoses, postoperative medications, and laboratory results were examined. Multivariate logistic regression models were used to identify characteristics independently associated with readmission overall and by amputation location-above the knee (AKA) or below the knee (BKA).
Readmission within 30 days of discharge.
More than one half of patients (1403, 57%) underwent BKA and 1077 (43%) underwent AKA. Readmission within 30 days was 22% (24.1% BKA versus 19.4% AKA, P = .005). In multivariable logistic regression, factors associated with 30-day readmission after any amputation included BKA (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.15-1.74, P = .001), hypertension (OR 1.70, 95% CI 1.33-2.16), surgical-site infections (OR 1.44, 95% CI 1.02-2.04), heart failure (OR 1.39, 95% CI 1.10-1.75), discharge to a skilled nursing facility (OR 1.88, 95% CI 1.41-2.51), and emergency/urgent procedures (OR 1.32, 95% CI 1.04-1.67). At readmission, 13.3% of patients with a BKA required an AKA revision, and 21.3% had a diagnosis of surgical-site infection.
Risk factors for readmission after any amputation included cardiac comorbidities, associated postoperative medications, and discharge to a skilled nursing facility. The finding that acute arterial embolism or thrombosis and a BKA during the index admission was highly associated with readmission, combined with the high rates of 30-day conversion to an AKA when readmitted, suggests these patients more often develop stump complications or may be undertreated during the initial hospitalization.
III.
了解与下肢截肢术后再入院相关的危险因素可能有助于确定降低再入院率的目标。
评估下肢截肢手术后30天全因再入院的相关因素。
回顾性队列研究。
住院部。
从国家电子病历数据库Cerner Health Facts中选取2008年至2014年间共2480例接受下肢截肢手术的患者。
对人口统计学、诊断、术后用药及实验室检查结果进行单因素分析。采用多因素logistic回归模型确定与总体再入院以及按截肢部位（膝上[AKA]或膝下[BKA]）独立相关的特征。
出院后30天内再入院情况。
超过一半的患者（1403例，57%）接受了膝下截肢，1077例（43%）接受了膝上截肢。30天内再入院率为22%（膝下截肢为24.1%，膝上截肢为19.4%，P = .005）。在多因素logistic回归中，任何截肢术后30天再入院的相关因素包括膝下截肢（比值比[OR] 1.41，95%置信区间[CI] 1.15 - 1.74，P = .001）、高血压（OR 1.70，95% CI 1.33 - 2.16）、手术部位感染（OR 1.44，95% CI 1.02 - 2.04）、心力衰竭（OR 1.39，95% CI 1.10 - 1.75）、转至专业护理机构（OR 1.88，95% CI 1.41 - 2.51）以及急诊/紧急手术（OR 1.32，95% CI 1.04 - 1.67）。再入院时，膝下截肢患者中有13.3%需要进行膝上截肢翻修，21.3%被诊断为手术部位感染。
任何截肢术后再入院的危险因素包括心脏合并症、相关术后用药以及转至专业护理机构。首次入院时急性动脉栓塞或血栓形成以及膝下截肢与再入院高度相关，再入院时30天内转为膝上截肢的比例较高，这表明这些患者更常出现残端并发症或在初次住院期间可能未得到充分治疗。
III级。
