Ratliff Hunter T, Shibuya Naohiro, Jupiter Daniel C
School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States.
Texas A&M University, College of Medicine, Temple, TX, United States; Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX, United States.
J Diabetes Complications. 2021 May;35(5):107886. doi: 10.1016/j.jdiacomp.2021.107886. Epub 2021 Feb 15.
The objective of this study was comparing medium-term outcomes between comparable minor and major amputations in adults with diabetes.
We used data from the 2016-2017 National Readmissions Database to construct a representative cohort of 15,581 adults with diabetes with lower extremity amputations. Patients were categorized by level of index amputation (major/minor), and propensity score matched to compare outcomes in candidates for either level of amputation. Readmission and reamputations were assessed at 1, 3, and 6 months following index amputation.
In the 6 months following index amputation, large proportions of patients were readmitted (n = 7597, 48.8%) or had reamputations (n = 1990, 12.8%). Patients with minor amputations had greater odds of readmission (OR = 1.25; 95% CI 1.18-1.31), reamputation (OR = 3.71; 95% CI 3.34-4.12), and more proximal reamputation (OR = 2.61; 95% 2.33-2.93) (all P < 0.001). Further, minor amputation patients had higher and lower odds of readmission for postoperative infection (OR = 4.45; 95% CI 3.27-6.05), or sepsis (OR = 0.79; 95% CI 0.68-0.93), respectively.
Patients desire to save as much limb as possible and should be counseled on higher risk for reamputation, readmission, and infection with minor amputations.
本研究的目的是比较糖尿病成人患者中类似的小截肢和大截肢的中期结局。
我们使用2016 - 2017年全国再入院数据库的数据，构建了一个包含15581例糖尿病下肢截肢成人患者的代表性队列。根据首次截肢水平（大/小）对患者进行分类，并进行倾向得分匹配，以比较两种截肢水平患者的结局。在首次截肢后的1、3和6个月评估再入院和再次截肢情况。
在首次截肢后的6个月内，很大比例的患者再次入院（n = 7597，48.8%）或进行了再次截肢（n = 1990，12.8%）。小截肢患者再次入院（OR = 1.25；95% CI 1.18 - 1.31）、再次截肢（OR = 3.71；95% CI 3.34 - 4.12）以及更靠近近端的再次截肢（OR = 2.61；95% 2.33 - 2.93）的几率更高（所有P < 0.001）。此外，小截肢患者因术后感染再次入院的几率更高（OR = 4.45；95% CI 3.27 - 6.05），而因败血症再次入院的几率更低（OR = 0.79；95% CI 0.68 - 0.93）。
患者希望尽可能多地保留肢体，应告知他们小截肢后再次截肢、再入院和感染的风险更高。
