Comparative evaluation of transcutaneous oxygen tension and ankle-brachial index as predictors of reoperation following below-knee amputation.

Autor:	Braet DJ; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI. Electronic address: djbraet@med.umich.edu., Pourak K; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI., Delbono L; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI., Powell C; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI., Smith ME; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI., Schechtman D; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI., Obi AT; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI., Coleman DM; Department of Surgery, Division of Vascular Surgery, Duke University School of Medicine, Durham, NC., Corriere MA; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2024 Jul; Vol. 80 (1), pp. 223-231.e2. Date of Electronic Publication: 2024 Feb 29.
DOI:	10.1016/j.jvs.2024.02.031
Abstrakt:	Objective: Decision-making regarding level of lower extremity amputation is sometimes challenging. Selecting an appropriate anatomic level for major amputation requires consideration of tradeoffs between postoperative function and risk of wound complications that may require additional operations, including debridement and/or conversion to above-knee amputation (AKA). We evaluated the utility of common, non-invasive diagnostic tests used in clinical practice to predict the need for reoperations among patients undergoing primary, elective, below knee-amputations (BKAs) by vascular surgeons. Methods: Patients undergoing elective BKA over a 5-year period were identified using Current Procedural Terminology codes. Medical records were reviewed to characterize demographics, pre-amputation testing transcutaneous oxygen tension (TcPO 2 ), and ankle-brachial index (ABI). The need for ipsilateral post-BKA reoperation (including BKA revision and/or conversion to AKA) regardless of indication was the primary outcome. Associations were evaluated using univariable and multivariable logistic regression models. Cutpoints for TcPO 2 values associated with amputation reoperation were evaluated using receiver operating characteristic curves. Results: We identified 175 BKAs, of which 46 (26.3%) required ipsilateral reoperation (18.9% BKA revisions and 14.3% conversions to AKA). The mean age was 63.3 ± 14.8 years. Most patients were male (65.1%) and White (72.0%). Mean pre-amputation calf TcPO 2 was 40.0 ± 20.5 mmHg, and mean ABI was 0.64 ± 0.45. In univariable models, post-BKA reoperation was associated with calf TcPO 2 (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.94-0.99; P = .013) but not ABI (OR, 0.53; 95% CI, 0.19-1.46; P = .217). Univariable associations with reoperation were also identified for age (OR, 0.97; 95% CI, 0.94-0.990; P = .003) and diabetes (OR, 0.43; 95% CI, 0.21-0.87; P = .019). No associations with amputation revision were identified for gender, race, end-stage renal disease, or preoperative antibiotics. Calf TcPO 2 remained associated with post-BKA reoperation in a multivariable model (OR, 0.97; 95% CI, 0.94-0.99; P = .022) adjusted for age (OR, 0.98; 95% CI, 0.94-1.01; P = .222) and diabetes (OR, 0.98; 95% CI, 0.94-1.01; P = .559). Receiver operating characteristic analysis suggested a TcPO 2 ≥38 mmHg as an appropriate cut-point for assessing risk for BKA revision (area under the curve = 0.682; negative predictive value, 0.91). Conclusions: Reoperation after BKA is common, and reoperation risk was associated with pre-amputation TcPO 2 . For patients undergoing elective BKA, higher risk of reoperation should be discussed with patients with an ipsilateral TcPO 2  <38 mmHg. Competing Interests: Disclosures None. (Copyright © 2024 Society for Vascular Surgery. All rights reserved.)
Databáze:	MEDLINE
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