Amputee Associates, LLC, Nashville, TN.
Michigan Vascular Center, Michigan State University, Flint, MI.
Ann Vasc Surg. 2024 Aug;105:99-105. doi: 10.1016/j.avsg.2024.02.010. Epub 2024 Apr 8.
Clinical outcomes after major lower-limb amputation have been historically poor. The current care provided to most amputees is often disorganized and without physician supervision. The primary purpose of this study is to examine rates of postamputation mobility achieved with a prosthesis by patients with chronic limb-threatening ischemia and/or diabetes who required major lower-limb amputation and were treated under an established physician-led collaborative care pathway. The secondary purpose is to describe the structure and utilization of the care pathway by multiple independent vascular surgery practices in the United States to enable future exploration of its impact on key clinical outcomes within this patient population.
Clinical records of 2,475 patients from 6 vascular practices that adopted this collaborative care pathway between 2017 and 2020 were retrospectively reviewed. Only records with sufficient documented histories of amputation surgeries, prosthetic services, and mobility status were included.
Of 2,475 patient records reviewed, 1,787 patients (2,157 major amputations) were eligible for analysis. Sixty-two-point 2 percent (n = 1,111) of patients achieved mobility with the collaborative care pathway. Mobility rate varied by amputation level in the study. Prosthetic mobility was achieved in 73.5% of transtibial amputations, 40.4% of transfemoral amputations, and 35.7% of through-knee amputations, regardless of patient laterality, which is superior or equivalent to the best published rates of mobility.
The study describes the structure and utilization of a physician-led collaborative care pathway for treating patients who require lower-limb amputation that meets 5 of the 7 recommendations from the 2019 Global Vascular Guidelines on the Management of Chronic Limb Threatening Ischemia. Internal data analysis results suggest that patients treated via this care pathway can potentially achieve improved mobility rates with a prosthesis following amputation. This collaborative care pathway should be further evaluated for its ability to directly improve mobility and other clinically relevant amputation outcomes.
下肢大截肢后的临床结果历来不佳。目前为大多数截肢者提供的护理往往缺乏组织性，且没有医生监督。本研究的主要目的是检查患有慢性肢体威胁性缺血和/或糖尿病且需要大下肢截肢的患者在既定的医生主导的协作护理路径下使用假肢获得的截肢后移动能力的比率。次要目的是描述美国多个独立血管外科实践中护理路径的结构和利用情况，以便在未来探索其对该患者群体中关键临床结果的影响。
回顾性审查了 2017 年至 2020 年期间采用这种协作护理路径的 6 个血管实践的 2475 名患者的临床记录。仅包括有足够的截肢手术、假肢服务和移动状态记录的记录。
在审查的 2475 份患者记录中，有 1787 名患者（2157 例大截肢）符合分析条件。62.2%（n=1111）的患者通过协作护理路径实现了移动能力。研究中截肢水平的移动率有所不同。经胫骨截肢术的假肢移动率为 73.5%，股骨截肢术为 40.4%，膝下截肢术为 35.7%，无论患者的偏侧性如何，这都优于或等同于移动能力的最佳已发表率。
本研究描述了一种由医生主导的协作护理路径的结构和利用情况，用于治疗需要下肢截肢的患者，该路径符合 2019 年全球血管指南中关于慢性肢体威胁性缺血管理的 7 项建议中的 5 项。内部数据分析结果表明，通过该护理路径治疗的患者在截肢后使用假肢可能会提高移动能力。应该进一步评估这种协作护理路径直接提高移动能力和其他临床相关截肢结果的能力。
