Reamputation Rate, Mortality, and the Incidence of Risk Factors for Ipsilateral Reamputation Among Patients with Dysvascular Major Lower Limb Amputation.

Autor:	Geurts RM; Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands. Electronic address: rick.geurts@ru.nl., Reetz D; Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands., Willems LH; Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands., van de Meent H; Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands., Warlé MC; Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands., van Petersen AS; Department of Surgery, Bernhoven Hospital, Uden, the Netherlands., Bendermacher BLW; Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands., Reijnen MMPJ; Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands., Frölke JPM; Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands., Leijendekkers RA; Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Department of Orthopedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; IQHealthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of vascular surgery [Ann Vasc Surg] 2024 Sep 27; Vol. 110 (Pt A), pp. 340-348. Date of Electronic Publication: 2024 Sep 27.
DOI:	10.1016/j.avsg.2024.07.116
Abstrakt:	Background: A major lower limb amputation (LLA) for dysvascular disease carries the risk of disturbed wound healing necessitating reamputation at a higher level. A reamputation causes a delay in prosthetic fitting and recovery of walking ability. The combination of a prolonged open wound and inability to walk can worsen the physical and psychological situation. Prevention of reamputation seems therefore important. This study aims to identify risk factors for reamputation, and to evaluate a possible altered mortality rate after a dysvascular major LLA. These issues are crucial for shared decision-making prior to surgery. Methods: Retrospective study investigating a Dutch regional cohort of patients with a dysvascular below-knee, through-knee, or above-knee LLA. Results: Five hundred sixteen dysvascular major LLAs were included (2014-2018). One hundred reamputations were performed within 1 year after initial amputation (19.4%). Risk factors for ipsilateral reamputation were diabetes mellitus, lipid-lowering drugs usage, and lower level of amputation (P ≤ 0.01, 0.037, and < 0.01, respectively). The 30-day mortality rates were 1% and 12% for the reamputation group and the nonreamputation group, respectively (P ≤ 0.01). The 1-year mortality rates were 23% and 27% for the reamputation group and the nonreamputation group, respectively (P = 0.423). Conclusions: Ipsilateral reamputation within 1 year after initial amputation is common. Several risk factors for reamputation were identified. The 30-day and 1-year mortality rate is high, but not significantly different after 1 year. A clinical decision tool for dysvascular patients needs to be developed to improve shared decision-making, reduce reamputation rates, and improve survival. (Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu