Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: https://twitter.com/argandykov.
Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: https://twitter.com/EmanueleLagazzi.
Am J Surg. 2024 Jun;232:95-101. doi: 10.1016/j.amjsurg.2024.01.011. Epub 2024 Feb 13.
This study aimed to evaluate whether lower extremity (LE) amputation among civilian casualties is a risk factor for venous thromboembolism.
All patients with severe LE injuries (AIS ≥3) derived from the ACS-TQIP (2013-2020) were divided into those who underwent trauma-associated amputation and those with limb salvage. Propensity score matching was used to mitigate selection bias and confounding and compare the rates of pulmonary embolism (PE) and deep vein thrombosis (DVT).
A total of 145,667 patients with severe LE injuries were included, with 3443 patients requiring LE amputation. After successful matching, patients sustaining LE amputation still experienced significantly higher rates of PE (4.2% vs. 2.5%, p < 0.001) and DVT (6.5% vs. 3.4%, p < 0.001). A sensitivity analysis examining patients with isolated major LE trauma similarly showed a higher rate of thromboembolic complications, including higher incidences of PE (3.2% vs. 2.0%, p = 0.015) and DVT (4.7% vs. 2.6%, p < 0.001).
In this nationwide analysis, traumatic lower extremity amputation is associated with a significantly higher risk of VTE events, including PE and DVT.
本研究旨在评估平民伤员下肢（LE）截肢是否是静脉血栓栓塞（VTE）的危险因素。
所有源自 ACS-TQIP（2013-2020 年）的严重 LE 损伤（AIS≥3）患者分为接受创伤相关截肢和保肢的患者。采用倾向评分匹配来减轻选择偏差和混杂，并比较肺栓塞（PE）和深静脉血栓形成（DVT）的发生率。
共纳入 145667 例严重 LE 损伤患者，其中 3443 例需要 LE 截肢。成功匹配后，接受 LE 截肢的患者仍经历更高的 PE（4.2% vs. 2.5%，p<0.001）和 DVT（6.5% vs. 3.4%，p<0.001）发生率。一项检查孤立性主要 LE 创伤患者的敏感性分析也显示出更高的血栓栓塞并发症发生率，包括更高的 PE 发生率（3.2% vs. 2.0%，p=0.015）和 DVT 发生率（4.7% vs. 2.6%，p<0.001）。
在这项全国性分析中，创伤性下肢截肢与 VTE 事件，包括 PE 和 DVT 的发生风险显著增加相关。
