Department of Vascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.
Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan.
Vascular. 2021 Dec;29(6):897-904. doi: 10.1177/1708538120980216. Epub 2021 Feb 21.
The aim of this study was to determine the relationship between preoperative nutritional status and wound healing in patients undergoing surgical reconstruction for ischemic tissue loss.
The preoperative nutritional status of patients who underwent surgical reconstruction for ischemic tissue loss for the years 2011-2018 was retrospectively estimated using the Controlling Nutritional Status (CONUT) score. Patients were allocated to two groups: Group I, normal nutrition or mild malnutrition (CONUT score ≤4), and Group II, moderate-to-severe malnutrition (CONUT score ≥5). Wound healing was set as the primary endpoint and major amputation and death as the secondary endpoints. The wound healing, limb salvage, and overall survival rates were calculated after two years using the Kaplan-Meier method, and Cox proportional hazards regression analysis was performed to determine which variables were independently associated with these outcomes.
Forty-eight patients with missing values for the CONUT score were excluded. A total of 174 limbs in 147 patients were studied (Group I: 115 limbs in 100 patients; Group II: 59 limbs in 47 patients). The mean duration of the study was 519 ± 270 days. The Kaplan-Meier curves showed that wound healing in Group I was superior to that in Group II (Group I vs. II: two-year wound healing, 97% vs. 79%; time to 50% wound healing, 83 vs. 150 days, <0.001), and multivariate analysis showed that the CONUT score was an independent predictor of wound healing (hazard ratio, 0.63; 95% confidence interval, 0.41-0.98; =0.038).
Patients with better preoperative nutritional status are more likely to experience wound healing earlier than those with excessive malnutrition.
本研究旨在确定接受缺血性组织损失手术重建的患者术前营养状况与伤口愈合之间的关系。
回顾性评估了 2011 年至 2018 年接受缺血性组织损失手术重建的患者的术前营养状况，使用 CONUT 评分。患者被分为两组：I 组，正常营养或轻度营养不良（CONUT 评分≤4），和 II 组，中重度营养不良（CONUT 评分≥5）。以伤口愈合为主要终点，以大截肢和死亡为次要终点。采用 Kaplan-Meier 法计算术后 2 年的伤口愈合、肢体保留和总生存率，并进行 Cox 比例风险回归分析，以确定哪些变量与这些结果独立相关。
排除了 48 例 CONUT 评分缺失值的患者。共对 147 例患者的 174 个肢体进行了研究（I 组：100 例患者 115 个肢体；II 组：47 例患者 59 个肢体）。研究的平均持续时间为 519±270 天。Kaplan-Meier 曲线显示，I 组的伤口愈合优于 II 组（I 组 vs. II 组：两年伤口愈合率，97% vs. 79%；50%伤口愈合时间，83 天 vs. 150 天，<0.001），多变量分析显示 CONUT 评分是伤口愈合的独立预测因子（风险比，0.63；95%置信区间，0.41-0.98；=0.038）。
术前营养状况较好的患者比营养不良过度的患者更有可能更早地实现伤口愈合。
