Sickels Angela D, Hua Clara, Dees Kory, Banks C Adam, Novak Zdenek, Carr Conley, Busby Courtney, Beck Adam W, Spangler Emily L
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
Ann Vasc Surg. 2025 May 2;119:99-110. doi: 10.1016/j.avsg.2025.04.125.
Enhanced recovery programs (ERPs) may improve lower extremity amputation (LEA) care through interdisciplinary collaboration, patient education, multimodal pain control, and early mobilization. We sought to determine the ERP impact on outcomes for patients undergoing major LEA.
Patients receiving ERP care (02/01/2022-07/31/2023) were compared to a historic pre-ERP cohort (01/01/2020-01/31/2022). Outcomes analyzed included length of stay (LOS), perioperative complications, time to prosthetic receipt, and achieved K-level.
220 and 152 patients were in the pre-ERP and ERP groups, respectively. In the pre-ERP group, the most common indication was infection (45.0% vs. 25.2%), while in the ERP group, rest pain was most common (37.1% vs. 10.5%), P < 0.001. Staged (i.e., initial amputation followed by closure at a subsequent operation) ERP patients had lower rates of 30-day readmissions (11.9% vs. 29.3%, P = 0.01) and 90-day complications (49.3% vs. 68.0%, P = 0.02) than staged non-ERP patients. ERP below-knee amputation (BKA) patients had lower 90-day mortality than pre-ERP patients (2.5% vs. 12.2%, P = 0.02). ERP above-knee amputation (AKA) patients had a shorter LOS than pre-ERP patients (6 vs. 7 days, P = 0.04). The ERP cohort had shorter prosthetic receipt times (176 vs. 226 days, log-rank P = 0.02). Patients who achieved at least a K1 level of ambulation had greater 18-month survival compared to patients who never ambulated (log-rank P < 0.001).
ERP implementation was associated with fewer complications and readmissions, most pronounced in ERP-staged patients. ERP patients tended to receive a prosthesis more quickly, which is important given the association of ambulation with survival. Significant comorbidities in this patient population highlight the importance of optimization efforts promoted by the ERP.
强化康复计划（ERPs）可通过多学科协作、患者教育、多模式疼痛控制和早期活动来改善下肢截肢（LEA）护理。我们试图确定ERP对接受大肢体截肢患者结局的影响。
将接受ERP护理的患者（2022年2月1日至2023年7月31日）与历史上ERP实施前的队列（2020年1月1日至2022年1月31日）进行比较。分析的结局包括住院时间（LOS）、围手术期并发症、接受假肢的时间以及达到的K级。
ERP实施前组和ERP组分别有220例和152例患者。在ERP实施前组，最常见的指征是感染（45.0%对25.2%），而在ERP组，静息痛最为常见（37.1%对10.5%），P<0.001。分期（即初次截肢后在后续手术中闭合）的ERP患者30天再入院率（11.9%对29.3%，P = 0.01）和90天并发症发生率（49.3%对68.0%，P = 0.02）低于分期的非ERP患者。ERP膝下截肢（BKA）患者的90天死亡率低于ERP实施前的患者（2.5%对12.2%，P = 0.02）。ERP膝上截肢（AKA）患者的住院时间比ERP实施前的患者短（6天对7天，P = 0.04）。ERP队列接受假肢的时间更短（176天对226天，对数秩检验P = 0.02）。与从未行走的患者相比，达到至少K1级行走水平的患者18个月生存率更高（对数秩检验P<0.001）。
ERP的实施与更少的并发症和再入院相关，在分期的ERP患者中最为明显。ERP患者倾向于更快接受假肢，鉴于行走与生存的关联，这一点很重要。该患者群体中显著的合并症凸显了ERP所推动的优化努力的重要性。
