Kasiri Mohammad Mahdi, Mittlboeck Martina, Gollackner Bernd, Neumayer Christoph
Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, 1090 Vienna, Austria.
Institute of Clinical Biometrics, Center for Medical Data Science, Medical University of Vienna, 1090 Vienna, Austria.
Diseases. 2024 Jun 27;12(7):133. doi: 10.3390/diseases12070133.
Patients with peripheral artery disease (PAD) have 40-70% higher three-year mortality after lower limb amputation compared to non-amputees. In this study, we examined the consequences of delayed treatment for patients with PAD during the coronavirus disease 2019 (COVID-19) pandemic.
This study employed a retrospective single-centre cohort design at a large tertiary care hospital. We compared amputees with PAD during the initial COVID-19 outbreak period in 2020 with a control group of amputees from 2019 after a three-year follow-up.
In total, 134 amputees with PAD were included due to unsuccessful revascularization ( = 84 in 2020 vs. = 50 in 2019). Patients in 2020 were significantly younger than those in 2019 ( = 0.01) and mostly admitted with advanced stages of PAD ( < 0.03). The proportion of major limb amputations increased significantly in 2020 ( = 0.03). Non-COVID-19-related deaths among patients in 2020 were more than twice as many as those in 2019, and long-term mortality in 2020 was 49% compared to 39% in 2019 ( = 0.04). Diabetes and renal insufficiency had a significantly negative impact on the survival of amputees with PAD ( < 0.01).
Delayed treatment in patients with PAD leads to high long-term mortality risk after amputation, especially in PAD patients with diabetes and renal insufficiency. Therefore, in future pandemics, continuously monitoring patients with PAD will be crucial to prevent delayed treatment and severe short-term and long-term consequences.
与未接受截肢的患者相比，外周动脉疾病（PAD）患者下肢截肢后的三年死亡率高出40%-70%。在本研究中，我们调查了2019冠状病毒病（COVID-19）大流行期间PAD患者延迟治疗的后果。
本研究在一家大型三级护理医院采用回顾性单中心队列设计。我们将2020年COVID-19首次爆发期间的PAD截肢患者与2019年的截肢对照组进行了三年随访后的比较。
由于血管重建失败，共纳入134例PAD截肢患者（2020年84例，2019年50例）。2020年的患者明显比2019年的患者年轻（P=0.01），且大多因PAD晚期入院（P<0.03）。2020年大肢体截肢的比例显著增加（P=0.03）。2020年患者中与COVID-19无关的死亡人数是2019年的两倍多，2020年的长期死亡率为49%，而2019年为39%（P=0.04）。糖尿病和肾功能不全对PAD截肢患者的生存有显著负面影响（P<0.01）。
PAD患者的延迟治疗会导致截肢后长期死亡风险较高，尤其是糖尿病和肾功能不全的PAD患者。因此，在未来的大流行中，持续监测PAD患者对于预防延迟治疗以及严重的短期和长期后果至关重要。
