Department of Surgery, Amphia Hospital, Breda, The Netherlands.
Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
Clin Interv Aging. 2019 Jul 2;14:1177-1185. doi: 10.2147/CIA.S206446. eCollection 2019.
Despite high amputation rates, data on patient-reported outcomes is scarce in the elderly population with critical limb ischemia. The aim of this study was to provide mortality rates and long-term changes of the following patient-reported outcomes in elderly critical limb ischemia amputees: quality of life (QoL), health status (HS), and symptoms of depression.
In this prospective observational cohort study, amputated critical limb ischemia patients ≥70 years were included. The follow-up period was two years. Within the follow-up period patients completed the following questionnaires: the World Health Organization Quality Of Life -abbreviated version of the WHOQOL 100 (WHOQOL-BREF), the 12-Item Short Form Health Survey, and the Center for Epidemiological Studies Depression Scale.
A total of 49 elderly patients with critical limb ischemia had undergone major limb amputation within two years after inclusion. In these patients, the one-year mortality rate was 39% and the two-year mortality rate was 55%. The physical QoL was the only domain of the WHOQOL-BREF that improved significantly across time after amputation (p≤0.001). In the long-term, there was no difference in the ability to enjoy life (p=0.380) or the satisfaction in performing daily living activities (p=0.231) compared to the scores of the general elderly population. After amputation, the physical HS domain (p≤0.001) and the mental HS domain (p=0.002) improved. In the first year, amputees experienced less symptoms of depression (p=0.004).
Elderly critical limb ischemia amputees are a fragile population with high mortality rates. Their QoL and HS increased after major limb amputation as compared to the baseline situation and they experienced less symptoms of depression. Moreover, our results show that, in the long-term, major limb amputation in the elderly patients with critical limb ischemia shows an acceptable QoL, which, in some aspects, is comparable to the QoL of their peers. These results can improve the shared-decision making process that does not delay the timing of major limb amputation.
尽管截肢率很高，但关于重症肢体缺血老年患者的患者报告结局数据仍然很少。本研究旨在提供以下患者报告结局在老年重症肢体缺血截肢患者中的死亡率和长期变化：生活质量（QoL）、健康状况（HS）和抑郁症状。
在这项前瞻性观察队列研究中，纳入了年龄≥70 岁的接受大截肢的重症肢体缺血患者。随访期为两年。在随访期间，患者完成了以下问卷：世界卫生组织生活质量-世界卫生组织生活质量 100 简表（WHOQOL-BREF）、12 项简短健康调查和流行病学研究中心抑郁量表。
共有 49 例重症肢体缺血老年患者在纳入后两年内接受了大截肢。这些患者的一年死亡率为 39%，两年死亡率为 55%。截肢后，WHOQOL-BREF 的身体 QoL 是唯一一个随时间显著改善的领域（p≤0.001）。在长期内，与一般老年人群的评分相比，享受生活的能力（p=0.380）或进行日常生活活动的满意度（p=0.231）没有差异。截肢后，身体 HS 域（p≤0.001）和心理 HS 域（p=0.002）得到改善。在第一年，截肢者的抑郁症状较少（p=0.004）。
老年重症肢体缺血截肢患者是一个脆弱的人群，死亡率很高。与基线情况相比，他们的 QoL 和 HS 在大截肢后增加，并且抑郁症状较少。此外，我们的结果表明，在长期内，老年重症肢体缺血患者的大截肢显示出可接受的 QoL，在某些方面与同龄人相当。这些结果可以改善不会延迟大截肢时机的共同决策过程。
