Medical Student, Georgetown University School of Medicine, Washington, DC.
Medical Student, Department of Plastic and Reconstructive Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC.
J Foot Ankle Surg. 2021 May-Jun;60(3):567-576. doi: 10.1053/j.jfas.2020.06.027. Epub 2020 Sep 3.
Chronic wounds that lead to major lower extremity amputation have immense consequences on quality of life, and ultimately, mortality. However, mortality rates after lower extremity amputation for a chronic wound are broad within the literature and have escaped precise definition. This systematic review aims to quantify long-term mortality rates after major lower extremity amputation in the chronic wound population available in the existing literature. Ovid MEDLINE was searched for publications which provided mortality data after major, nontraumatic, primary lower extremity amputations. Lower extremity amputations were defined as below and above the knee amputation. Data from included studies was analyzed to obtain pooled 1-, 2-, 3-, 5- and 10-year mortality rates. Sixty-one studies satisfied inclusion criteria representing 36,037 patients who underwent nontraumatic major lower extremity amputation. Pooled mortality rates were 33.7%, 51.5%, 53%, 64.4%, and 80% at 1-, 2-, 3-, 5- and 10-year follow-up, respectively. Within the 8184 diabetic patients (types 1 and 2), 1- and 5-year mortality was 27.3% and 63.2%. Sources of mortality data were varied and included electronic medical records, national health and insurance registries, and government databases. Mortality after nontraumatic major lower extremity amputation is high, both in patients with diabetes as well as those without. Methods used to measure and report mortality are inconsistent, lack reliability, and may underestimate true mortality rates. These findings illustrate the need for a paradigm shift in wound management and improved outcomes reporting. A focus on amputation prevention and care within a multidisciplinary team is critical for recalcitrant ulcers.
导致下肢大截肢的慢性伤口对生活质量，最终对死亡率有巨大影响。然而，慢性伤口下肢截肢后的死亡率在文献中很广泛，尚未得到准确定义。本系统评价旨在量化现有文献中慢性伤口人群中下肢大截肢后的长期死亡率。在 Ovid MEDLINE 上搜索提供主要、非创伤性、原发性下肢截肢后死亡率数据的出版物。下肢截肢定义为膝下和膝上截肢。对纳入研究的数据进行分析，以获得汇总的 1、2、3、5 和 10 年死亡率。61 项研究符合纳入标准，代表了 36037 名接受非创伤性下肢大截肢的患者。汇总的死亡率分别为 1 年、2 年、3 年、5 年和 10 年随访时的 33.7%、51.5%、53%、64.4%和 80%。在 8184 例糖尿病患者（1 型和 2 型）中，1 年和 5 年的死亡率分别为 27.3%和 63.2%。死亡率数据来源各不相同，包括电子病历、国家健康和保险登记处以及政府数据库。非创伤性下肢大截肢后的死亡率很高，无论是糖尿病患者还是非糖尿病患者。用于测量和报告死亡率的方法不一致，缺乏可靠性，并且可能低估真实死亡率。这些发现说明了需要在伤口管理和改善结果报告方面转变观念。在多学科团队中，关注预防和护理截肢对于顽固的溃疡至关重要。
