Leinweber Maria Elisabeth, Greistorfer Emanuel, Rettig Julia, Taher Fadi, Kliewer Miriam, Assadian Afshin, Hofmann Amun Georg
Department of Vascular and Endovascular Surgery, KliniK Ottakring, Montleartstrasse 37, 1160 Vienna, Austria.
J Clin Med. 2024 Dec 27;14(1):104. doi: 10.3390/jcm14010104.
: Despite advancements in vascular surgery, the mortality among peripheral arterial disease (PAD) patients undergoing major amputations remains high. While a large body of evidence has previously covered survival rates after major amputation, there is less evidence regarding the associated survival penalty from an epidemiological perspective. The present analysis aimed at quantifying the survival disadvantage after major lower limb amputation while investigating which factors are associated with mortality in this patient cohort. : Data from 246 PAD patients undergoing major amputations were retrospectively collected and matched with mortality records from the Austrian National Death Registry. Life expectancy was estimated using population-based life tables, and differences between observed and expected survival were analyzed across subgroups. : The median follow-up was 492 days (Q1-Q3: 73-1438), and 82.5% (n = 203) of patients died, with cardiovascular events being the leading cause (41%). A profound discrepancy between estimated (4697 days, Q1-Q3: 2962-6236) and observed survival (457 days, Q1-Q3: 73-1438, < 0.001) was seen. In men, an associated median survival penalty of 11.2 years was observed, equivalent to a proportionate reduction in life expectancy of over 90%, while the difference in women was 8.7 years, equaling a reduction of 84.6%. In a multiple regression model, 1 year in life expectancy was associated with a survival penalty of -0.96 years, thereby affecting younger patients with the highest life expectancies the most. : Major amputation in PAD patients is associated with a significant reduction in survival compared to standardized mortality rates in the general population. The survival disadvantage exceeds 70% of estimated survival times in over 70% of patients. Elevated mortality rates after major amputation in PAD patients should not be interpreted as a causal relationship but as a surrogate for impaired systemic cardiovascular health.
尽管血管外科取得了进展，但接受大截肢手术的外周动脉疾病（PAD）患者的死亡率仍然很高。虽然此前有大量证据涵盖了大截肢后的生存率，但从流行病学角度来看，关于相关生存代价的证据较少。本分析旨在量化下肢大截肢后的生存劣势，同时调查该患者群体中哪些因素与死亡率相关。
回顾性收集了246例接受大截肢手术的PAD患者的数据，并与奥地利国家死亡登记处的死亡率记录进行匹配。使用基于人群的生命表估计预期寿命，并分析各亚组观察到的生存与预期生存之间的差异。
中位随访时间为492天（第一四分位数 - 第三四分位数：73 - 1438天），82.5%（n = 203）的患者死亡，心血管事件是主要死因（41%）。观察到估计生存时间（4697天，第一四分位数 - 第三四分位数：2962 - 6236天）与实际生存时间（457天，第一四分位数 - 第三四分位数：73 - 1438天，< 0.001）之间存在显著差异。在男性中，观察到相关的中位生存代价为11.2年，相当于预期寿命比例降低超过90%，而女性的差异为8.7年，相当于降低84.6%。在多元回归模型中，预期寿命每增加1年，生存代价为 -0.96年，因此对预期寿命最高的年轻患者影响最大。
与一般人群的标准化死亡率相比，PAD患者的大截肢与生存率显著降低相关。在超过70%的患者中，生存劣势超过估计生存时间的70%。PAD患者大截肢后死亡率升高不应被解释为因果关系，而应被视为全身心血管健康受损的替代指标。
