Predictors of Mortality and Revision Following Digital Amputation for Infection and Necrosis.

Autor:	Apel PJ; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, VA., Cripe BA; Virginia Tech Carilion, Department of Surgery, Plastic Surgery Section, VA., Schmitt MW; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, VA., Orfield NJ; Virginia Tech Carilion, Department of Surgery, Plastic Surgery Section, VA., Lozano AJ; Center for Biostatistics and Health Data Science, Department of Statistics, College of Science, Virginia Polytechnic Institute and State University, VA., Hanlon AL; Center for Biostatistics and Health Data Science, Department of Statistics, College of Science, Virginia Polytechnic Institute and State University, VA., Capito AE; Carilion Clinic, Department of Surgery, Plastic Surgery, VA. Electronic address: aecapito@carilionclinic.org.
Jazyk:	angličtina
Zdroj:	The Journal of hand surgery [J Hand Surg Am] 2023 May; Vol. 48 (5), pp. 460-467. Date of Electronic Publication: 2023 Mar 15.
DOI:	10.1016/j.jhsa.2023.01.014
Abstrakt:	Purpose: Digital amputation is a commonly performed procedure for infection and necrosis in patients with diabetes, peripheral vascular disease (PVD), and on dialysis. There is a lack of data regarding prognosis for revision amputation and mortality following digital amputation in these patients. Methods: All digital amputations over 10-year period (2008-2018) at a single center were reviewed. There were 484 amputations in 360 patients, among which 358 were performed for trauma (reference sample) and 126 for infection or necrosis (sample of interest). Patient death and revision were determined from National Vital Statistics System and medical records. Propensity score matching was performed to compare groups. Data were then compared to the Social Security Administration Actuarial Life Table for 2015 to determine age-matched expected mortality. Results: The 2-year revision rate was 34% for amputations performed for infection or necrosis, compared to 15% for amputations due to trauma. For amputations performed for infection or necrosis, the revision rate was 47.7% when diabetes, PVD, and dialysis were present. Among all patients with infection or necrosis (n = 104) undergoing a digital amputation, overall survival at 2, 5, and 10 years was 79.4%, 57.3%, and 17.5%, respectively, which represented a 3.2-fold increased risk of death compared to controls. (hazard ratio, 3.19; 95% confidence interval, 1.47-6.93). For amputations due to trauma, mortality was no different from that in the age-matched general population. Conclusions: Mortality and revision risk are high for patients requiring a digital amputation for infection or necrosis and are further increased with medical comorbidities. Hand surgeons should consider the prognostic implications of these data when counseling patients. Type of Study/level of Evidence: Prognostic IV. (Copyright © 2023. Published by Elsevier Inc.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu