Yağız Betül Keskinkılıç, Göktuğ Ufuk Utku, Sapmaz Ali, Dinç Tolga, Budak Ali Baran, Terzioğlu Serdar Gökay
Ministry of Health Samsun Gazi State Hospital, Department of General Surgery, Samsun, Turkey.
Yeditepe University Faculty of Medicine, Department of General Surgery, Istanbul, Turkey.
J Wound Care. 2023 Dec 2;32(12):805-810. doi: 10.12968/jowc.2023.32.12.805.
Major lower limb amputation is generally associated with a high risk of early and late-term mortality. In this study, 30-day, one-year and three-year mortality of non-traumatic major lower extremity amputations and comorbidities affecting the mortality rate were investigated.
Patients who underwent a major lower limb amputation secondary to diabetes or peripheral artery disease between the years 2010-2015 were retrospectively evaluated. Additional to patient demographic data and comorbidities, amputation level, survival and mortality time were extracted. Mortality rates after 30 days, one year and three years were analysed. The associations of the survival to different parameters were evaluated with Kaplan-Meier analysis and log rank test, while the impact of the risk factors on mortality was evaluated with the Cox regression test.
A total of 193 patients were enrolled in the study. Approximately 60% of patients were aged ≥65 years, and 65.8% were male. Below-knee amputation was performed in 64.8% of patients and above-knee amputation in 35.2% of patients. The mean follow-up of patients was 29.48 months (range: 0-101 months). After non-traumatic major lower extremity amputation, 30-day, one-year and three-year mortality were 16.6%, 38.3% and 60.1%, respectively. On Cox regression analysis, age ≥65 years was the only variable that had significant impact on the 30-day mortality (hazard ratio (HR): 3.4; p=0.012), while age ≥65 years (HR: 2.5, p=0.000), diabetes (HR: 2, p=0.006) and renal failure (HR: 2, p=0.001) were found to have significant impacts on three-year mortality.
The findings of this study showed that >50% of patients with non-traumatic major lower limb amputations died within three years. Advanced age, diabetes and renal failure were the risk factors that increased the mortality. The high mortality rates revealed the importance of employing all hard-to-heal wound treatment options before making an amputation decision. Further, prospective studies are needed to determine the effects of primary disease status and timing of amputation on mortality.
下肢大截肢通常与早期和晚期死亡的高风险相关。在本研究中，调查了非创伤性下肢大截肢的30天、1年和3年死亡率以及影响死亡率的合并症。
对2010年至2015年间因糖尿病或外周动脉疾病接受下肢大截肢的患者进行回顾性评估。除患者人口统计学数据和合并症外，提取截肢水平、生存和死亡时间。分析30天、1年和3年后的死亡率。采用Kaplan-Meier分析和对数秩检验评估不同参数与生存的关联，同时采用Cox回归检验评估危险因素对死亡率的影响。
本研究共纳入193例患者。约60%的患者年龄≥65岁，65.8%为男性。64.8%的患者进行了膝下截肢，35.2%的患者进行了膝上截肢。患者的平均随访时间为29.48个月（范围：0至101个月）。非创伤性下肢大截肢后，30天、1年和3年死亡率分别为16.6%、38.3%和60.1%。Cox回归分析显示，年龄≥65岁是对30天死亡率有显著影响的唯一变量（风险比（HR）：3.4；p = 0.012），而年龄≥65岁（HR：2.5，p = 0.000）、糖尿病（HR：2，p = 0.006）和肾衰竭（HR：2，p = 0.001）对3年死亡率有显著影响。
本研究结果表明，超过50%的非创伤性下肢大截肢患者在3年内死亡。高龄、糖尿病和肾衰竭是增加死亡率的危险因素。高死亡率揭示了在做出截肢决定前采用所有难愈合伤口治疗方案的重要性。此外，需要进行前瞻性研究以确定原发疾病状态和截肢时机对死亡率的影响。
