Chao Natalie, Som Maria, Workneh Eyerusalem, Karwoski Allison, Dunlap Eleanor, Fitzpatrick Suzanna, Nagarsheth Khanjan
Vascular Surgery, University of Maryland School of Medicine, Baltimore, USA.
Vascular Surgery, University of Maryland Medical Center, Baltimore, USA.
Cureus. 2023 May 19;15(5):e39215. doi: 10.7759/cureus.39215. eCollection 2023 May.
Objective We aim to compare the effects of pre-existing mood disorders and chronic kidney disease (CKD) on ambulation outcomes for patients who have undergone major lower extremity amputation (MLEA) while also stratifying by the presence of social factors. Methods We performed a retrospective chart review of 700 patients admitted from 2014 to 2022 who underwent MLEA. We performed Chi-square tests and binomial logistic regression with p < 0.05 as our significance level. Results Mood disorder patients have higher rates of independent ambulation if they have familial support (p = 0.022), a listed primary care provider (PCP; p = 0.013), a six-month follow-up (p < 0.001), or a one-year follow-up (p < 0.001). Patients with a history of mood disorder have significantly decreased odds of prosthesis usage (OR: 0.58, 95% CI: 0.40-0.86) but have higher rates of prosthesis usage if they have familial support (p = 0.002), a PCP listed (p = 0.005), a six-month follow-up (p < 0.001), or a one-year follow-up (p < 0.001). CKD patients have significantly decreased odds of eventual independent ambulation (OR: 0.69, 95% CI: 0.49-0.97) but have significantly increased rates of independent ambulation if they have familial support (p =0.041) and six-month (p < 0.001) or one-year follow-up (p < 0.001). CKD patients only have significant changes in prosthesis usage with a six-month (p < 0.001) or one-year follow-up (p < 0.001). Conclusions Pre-existing CKD and mood disorders are associated with decreased odds of independent ambulation and prosthesis usage, respectively. Social factors such as family support, a listed PCP, and timely follow-up are associated with markedly improved ambulatory outcomes for MLEA patients with mood disorders and CKD, with significantly improved prosthesis usage outcomes in only the mood disorder population.
目的 我们旨在比较既往存在的情绪障碍和慢性肾脏病（CKD）对接受主要下肢截肢（MLEA）患者步行结果的影响，同时按社会因素的存在情况进行分层。方法 我们对2014年至2022年期间入院接受MLEA的700例患者进行了回顾性病历审查。我们进行了卡方检验和二项逻辑回归，显著性水平为p < 0.05。结果 情绪障碍患者如果有家庭支持（p = 0.022）、有列出的初级保健提供者（PCP；p = 0.013）、有六个月随访（p < 0.001）或一年随访（p < 0.001），则独立行走的比例较高。有情绪障碍病史的患者使用假肢的几率显著降低（OR：0.58，95%CI：0.40 - 0.86），但如果有家庭支持（p = 0.002）、有列出的PCP（p = 0.005）、有六个月随访（p < 0.001）或一年随访（p < 0.001），则使用假肢的比例较高。CKD患者最终独立行走的几率显著降低（OR：0.69，95%CI：0.49 - 0.97），但如果有家庭支持（p = 0.041）以及六个月（p < 0.001）或一年随访（p < 0.001），则独立行走的比例显著增加。CKD患者仅在六个月（p < 0.001）或一年随访（p < 0.001）时假肢使用情况有显著变化。结论 既往存在的CKD和情绪障碍分别与独立行走几率降低和假肢使用几率降低相关。家庭支持、列出的PCP和及时随访等社会因素与患有情绪障碍和CKD的MLEA患者的步行结果显著改善相关，仅在情绪障碍人群中假肢使用结果有显著改善。
