Abdel Rahim A, Tam A, Holmes M, Mittapalli D
Department of Vascular Surgery, University Hospitals Plymouth NHS Trust, United Kingdom.
Ann Med Surg (Lond). 2022 Nov 12;84:104864. doi: 10.1016/j.amsu.2022.104864. eCollection 2022 Dec.
Non-traumatic lower limb amputation is a commonly performed surgical procedure and is associated with a high prevalence of psychological morbidity including anxiety and depression. Many risk factors have been identified, including the indication for amputation, perioperative pain and sociodemographic factors.
The aim of this study was to identify whether level of amputation has an impact on this psychological morbidity.
A prospective observational study was conducted in a tertiary vascular unit including all adult non-traumatic amputations performed during a 6 month period. The Hospital Anxiety and Depression Scale (HADS) was used to score anxiety and depression pre and postoperatively.
49 patients met the inclusion criteria (22 trans-femoral amputations (AKA) and 27 trans-tibial amputations (BKA)). HADS scores for anxiety and depression were high in both groups both pre and postoperatively. A higher level of anxiety was noted in the BKA group, significantly decreasing postoperatively (p < 0.05). No other statistically significant differences were found between the two groups.
In non-traumatic amputations, there appears to be a higher rate of pre-operative anxiety in patients undergoing trans-tibial amputation compared with trans-femoral amputees. However, the level of amputation does not appear to have a significant effect on psychological status of patients with high rates of depression and anxiety demonstrated in both groups.
非创伤性下肢截肢是一种常见的外科手术，且与包括焦虑和抑郁在内的高心理发病率相关。已确定许多风险因素，包括截肢指征、围手术期疼痛和社会人口统计学因素。
本研究的目的是确定截肢水平是否会对这种心理发病率产生影响。
在一家三级血管科进行了一项前瞻性观察研究，纳入了6个月期间所有成年非创伤性截肢患者。采用医院焦虑抑郁量表（HADS）对患者术前和术后的焦虑和抑郁进行评分。
49例患者符合纳入标准（22例经股截肢（AKA）和27例经胫截肢（BKA））。两组患者术前和术后的HADS焦虑和抑郁评分均较高。BKA组的焦虑水平较高，术后显著降低（p<0.05）。两组之间未发现其他统计学上的显著差异。
在非创伤性截肢中，与经股截肢患者相比，经胫截肢患者术前焦虑率似乎更高。然而，截肢水平似乎对两组中均表现出的高抑郁和焦虑率患者的心理状态没有显著影响。
