Evaluating the Role of Major Lower Extremity Amputation in Nonagenarians.

Autor:	Zaza SI; Division of Vascular Surgery, Department of Surgery, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI., Rectenwald JE; Division of Vascular Surgery, Department of Surgery, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI., Bennett KM; Division of Vascular Surgery, Department of Surgery, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI. Electronic address: bennettK@surgery.wisc.edu.
Jazyk:	angličtina
Zdroj:	Annals of vascular surgery [Ann Vasc Surg] 2023 Sep; Vol. 95, pp. 178-183. Date of Electronic Publication: 2023 Apr 15.
DOI:	10.1016/j.avsg.2023.04.003
Abstrakt:	Objective: Elderly patients with critical limb ischemia are an especially frail and vulnerable group of patients. There is little literature investigating outcomes and resource utilization in nonagenarians undergoing major lower extremity amputation (MLEA). This study aims to elucidate the outcomes of this unique set of patients for whom amputation may often be considered a "palliative" intervention. Methods: Analyzing over 16,000 records from the Vascular Quality Initiative (VQI) database, we collected demographic, operative, and postoperative data on all patients who underwent an MLEA. We performed univariate analysis comparing nonagenarians to younger patients examining both short-term and long-term outcomes. Multimodel inference was used to analyze the effect of age on clinically meaningful outcomes: mortality and long-term living disposition. Results: With 392 nonagenarians and 16,349 patients under the age of 90, we found nonagenarians were less comorbid and less likely to have a prior bypass or amputation. Despite experiencing lower rates of reoperation and individual postoperative complications, nonagenarians suffered higher long-term mortality (46% vs. 22%, P < 0.0005) and were more likely to be living in a facility at follow-up (34% vs. 15%, P < 0.0005). Incorporating important demographic and clinical factors, multimodel inference demonstrated that, the nonagenarian age group was a critical predictor of nonhome living status (Akaike Importance weight 0.99). Conclusions: Although nonagenarians were less comorbid than their younger counterparts and suffered fewer perioperative complications, MLEA leads to a poorer outcome with significant mortality and a higher likelihood of residing in a facility at long-term follow-up. These findings underscore the importance of frank goals of care discussions in nonagenarians considering major amputation. (Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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