Department of Clinical Sciences, Lund University, Malmö, Sweden.
Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.
World J Surg. 2024 Mar;48(3):746-755. doi: 10.1002/wjs.12058. Epub 2024 Jan 2.
Previous reports have suggested higher rates of mortality and amputation for female patients in acute lower limb ischemia (ALI). The aims of the present study were to investigate if there is a difference in mortality, amputation, and fasciotomy between the sexes.
A retrospective cohort study of consecutive patients undergoing index revascularization for ALI between 2001 and 2018 was conducted. A propensity score was created through a logistic regression with female/male sex as an outcome. Cox regression analyses for 90-day and 1-year mortality, combining major amputation/mortality, and logistic regression for major bleeding and fasciotomy, were performed. All analyses were performed with and without adjusting for propensity score.
A total of 709 patients were included in the study of which 45.9% were women. Mean age was 72.1 years. Females were older and had higher rates of atrial fibrillation, embolic disease, and lower estimated glomerular filtration rate, while men more often had anemia and chronic peripheral arterial disease. Mortality at 1 year was 21.2% for women and 14.7% for men. The adjusted hazard ratio for 1-year mortality was 0.99 (95% CI 0.67-1.46). Fasciotomy was performed in 7.1% of female and 12.8% of male patients; the adjusted odds ratio was 0.52 (95% CI 0.29-0.91).
Sex was not found to be an independent risk factor for mortality or combined major amputation/mortality after revascularization for acute lower limb ischemia, whereas women had lower odds of undergoing fasciotomy. Whether women are underdiagnosed or do not develop acute compartment syndrome in the lower leg as often as men should be evaluated prospectively.
先前的报告表明，女性急性下肢缺血（ALI）患者的死亡率和截肢率较高。本研究旨在探讨男女之间在死亡率、截肢率和筋膜切开术方面是否存在差异。
对 2001 年至 2018 年间连续接受 ALI 指数再血管化治疗的患者进行回顾性队列研究。通过以女性/男性性别为结果的逻辑回归创建倾向评分。进行了 90 天和 1 年死亡率的 Cox 回归分析，将主要截肢/死亡率相结合，并进行了主要出血和筋膜切开术的 logistic 回归分析。所有分析均在不调整和调整倾向评分的情况下进行。
共纳入 709 例患者，其中 45.9%为女性。平均年龄为 72.1 岁。女性年龄较大，心房颤动、栓塞性疾病发生率较高，估算肾小球滤过率较低，而男性贫血和慢性外周动脉疾病发生率较高。女性 1 年死亡率为 21.2%，男性为 14.7%。1 年死亡率的调整危险比为 0.99（95%可信区间 0.67-1.46）。女性和男性筋膜切开术的比例分别为 7.1%和 12.8%；调整后的优势比为 0.52（95%可信区间 0.29-0.91）。
在急性下肢缺血再血管化治疗后，性别并不是死亡率或联合主要截肢/死亡率的独立危险因素，而女性进行筋膜切开术的可能性较低。是否女性的诊断不足或不像男性那样经常在小腿发生急性间隔综合征，应进行前瞻性评估。
