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Background
Many patients undergoing below knee amputations (BKA) return for subsequent unplanned operations, hospital readmission, or postoperative complications. This unplanned medical management negatively impacts both patient outcomes and our healthcare system. This study primarily investigates the risk factors for unplanned reoperation following BKA.Methods
Below knee amputations from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from the years 2012–2014 were identified by CPT code 27880 for amputation through the tibia and fibula. Our query identified 4631 BKA cases, including 30 day complications. Multivariate logistic regression modeling was performed on several patient demographic and disease factors to assess for independent predictors of unplanned reoperation. Secondary outcomes of unplanned and related readmissions (related to the procedure), major complications, minor complications, and mortality were also included in the analysis.Results
Of 4631 BKAs identified, 9.63% (446/4631) underwent unplanned reoperations and 8.75% (405/4631) had unplanned and related readmissions. Major complications were experienced by 12.8% (593/4631) and minor complications by 8.7% (401/4631). Thirty day mortality rate was 5.14% (238/4631). The most common procedures for unplanned operations were thigh amputations (128/446, 28.7%), debridement/secondary closure (114/446, 25.6%), and revision leg amputations (46/446, 10.32%). Factors associated with an increased risk of unplanned reoperation included patients transferred from another facility (Adjusted Odds Ratio [AOR]?=?1.28; p?=?.04), recent smokers (AOR?=?1.34; p?=?.02), bleeding disorder (AOR?=?1.30; p?=?.02), and preoperative ventilator use (AOR?=?2.38; p?=?.01).Conclusion
Patients that were ongoing/recent smokers, had diagnosed bleeding disorders, required preoperative ventilator use, or were transferred in from another facility were associated with the highest risks of reoperation following BKA. This patient population experiences high rates of reoperation, readmission, complication, and mortality. 相似文献3.
下肢严重损伤截肢与保留的计量诊断 总被引:9,自引:1,他引:8
取200例下肢严重损伤(截肢者与保留者各100例),应用评分方法,根据年龄、休克、伤口污染,皮肤、肌肉肌腱、骨关节、血管及神经损伤程度进行多因素两类判别分析,对伤肢进行计量诊断.结果显示:截肢组平均22.74分(17~28分),保留组15.77分(13~21分);判别方程Z=0.14X1+1.48X2+1.43X3+1.63X4+5.84X5+5.09X6+4.34X7+2.19X8,Z*=67.52.方差分析所建方程有高度显著意义(P<0.005).各因素对方程的贡献率以肌肉严重损伤对肢体威胁最大,其次为血管损伤,再次为骨关节损伤.原资料回代验证准确率为98%.由此认为,该方程对临床下肢严重损伤的伤情判断及决定伤肢保留与否有重要价值. 相似文献
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Amputation in elderly and high-risk vascular patients 总被引:1,自引:0,他引:1
Fifty-eight patients underwent lower limb amputation for arterial disease over a 30-month period. Mean age of the patients was 72 years. Cardiopulmonary and metabolic risk factors were present in the majority of the patients. Postoperative one-year and three-year mortality rates were 24, 40, and 76%, respectively. Contralateral amputation was required in one-third of the patients after a mean period of eight months. Only younger and healthier patients returned to a meaningful social life after appropriate prosthetic fitting. In view of the high mortality and morbidity rates, above-knee amputation seems a better choice than below-knee amputation in these elderly and high-risk patients. 相似文献
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Femoral Pseudoaneurysm in Drug Addicts—Excision without Revascularization is a Viable Option 总被引:6,自引:0,他引:6
S.A. Naqi H.M. Khan S. Akhtar T.A. Shah 《European journal of vascular and endovascular surgery》2006,31(6):585-587
PURPOSE: To present a series of patients presenting with femoral pseudoaneurysm. RESULTS: Seventeen patients who presented with a femoral pseudoaneurysm during a 1 year period were included in this study. Parenteral drug abuse was the most common aetiological factor. The femoral artery was most commonly involved at its bifurcation. Sixteen patients (94%) had excision of the pseudoaneurysm with ligation of vessel and debridement without any revascularization and one patient (6%) had reverse saphenous grafting after excision and ligation of vessels. Four amputations (23%) were performed. Three (17%) were major limb amputations, which included one above knee and two below knee amputations. Four patients (23%) developed intermittent claudication. CONCLUSION: Excision of the pseudoaneurysm with ligation of vessels and wide debridement without immediate revascularization in infected pseudoaneurysms is a safe and effective treatment. 相似文献
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GustiloⅢB和ⅢC高能量胫骨骨折--截肢与保肢的比较 总被引:2,自引:0,他引:2
截肢和保肢患者长期的功能和心理结果相似。如果早期不截肢而采取保肢,就必须考虑到:二期截肢的风险(5%~14%)、潜在的并发症(保肢术通常更高)以及住院时间延长。由于胫骨骨折严重程度不同采取的治疗可能不同(G ustiloⅢC型比ⅢB型更可能截肢),这使得对比很困难,而且相关的队列研究文献很少。 相似文献
8.
Background: There are many surgical procedures for the correction of hallux valgus and crossover 2nd toe deformity. Amputation of a crossover 2nd toe is often performed as a salvage procedure if the primary 2nd toe corrective procedure fails.Aims: To assess the outcomes of amputating a crossover 2nd toe in the presence of hallux valgus in elderly patients above 70 years old; as a primary procedure.Materials and methods: Seven patients (8 ft) underwent amputation of their crossover 2nd toe. A disease specific questionnaire using a Visual Analogue Scale (VAS) was implemented measuring pain, deformity, discomfort, and walking distance.Results: The mean age of the patients was 82 years old, range 74–89 years old. Amputation of the 2nd toe significantly reduces pain, discomfort and the appearance of deformity, there was no difference in the patient’s walking distance after surgery.Conclusion: We recommend this type of surgery as a primary procedure in elderly patients above 70 years old, if the first ray is not causing symptoms. 相似文献
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