背景:下肢截肢在大量外周血管疾病患者中仍然是必要的。下肢丢失后的5年生存率显着降低。这些患者中的许多人从未安装过假肢,并且缺乏有关假肢获得障碍的知识。这项研究的目的是确定不接受假体的风险因素以及严重截肢后活动水平对生存的影响。
方法:这是对2010年1月1日至2019年12月31日在我们的实践中由外科医生进行下肢截肢的所有患者的回顾性分析。抽象数据包括:年龄,性别,种族,体重指数(BMI),合并症,美国麻醉医师协会(ASA)评分,他汀类药物的使用,水平的截肢,树桩修订,适合假体,假体类型,美国医疗保险功能分类水平(MFCL)也称为K水平。生存率是使用多种来源的组合来确定的,包括社会保障死亡主档案,搜索多个家谱注册和一般互联网搜索。多变量逻辑回归用于确定与假体获得相关的危险因素。采用时间依赖性协变量的多变量Cox比例风险回归评估与5年死亡率相关的危险因素。
结果:464例患者纳入本研究。平均年龄为65岁,平均体重指数为27kg/m2。大多数患者为男性(68%),白色(56%),糖尿病(62%),高血压(76%),并接受膝下截肢术(BKA)(69%)。185例(40%)发生了假肢。在多变量分析中,年龄>81岁和目前的烟草使用与没有假体安装相关。5年总生存率为41.9%(95CI,37.6%-46.6%)(BKA47.7%[95CI,42.5%-53.5%],膝上截肢28.7%[95CI,22.1%-37.2%])。多变量分析年龄>60岁,CHF,AKA和无假体发育与存活率降低相关。K水平的增加与生存率的提高呈递增相关。
结论:这项研究确定了与假肢获得相关的几个患者因素,以及预测截肢后生存率降低的多种因素。被转诊为假体安装与患者特征和合并症无法解释的生存率提高相关。MFCLK水平预测生存率。需要更多的研究来确定假肢获得的障碍,以及提高患者的K水平是否会提高生存率。
OBJECTIVE: Lower extremity amputation continues to be necessary in a significant number of patients with peripheral vascular disease. The 5-year survival following lower limb loss is markedly reduced. Many of these patients are never fitted with a prosthesis, and there is a dearth of knowledge regarding the barriers to prosthetic attainment. The goal of this study was to identify the risk factors for not receiving a prosthesis and the effect of mobility level on survival following major amputation.
METHODS: This was a retrospective analysis of all patients that underwent lower extremity amputation by surgeons in our practice from January 1, 2010, to December 31, 2019. Abstracted data included: age, sex, race, body mass index, comorbidities, American Society of Anesthesiologists score, statin use, level of amputation, stump revision, fitting for prosthesis, type of prosthesis, and the United States\' Medicare Functional Classification Level, also called K level. Survival was determined using a combination of sources, including the Social Security Death Master File, searches of multiple genealogic registries, and general internet searches. Multivariable logistic regression was used to determine risk factors associated with prosthesis attainment. Multivariable Cox proportional hazard regression with time-dependent covariates was performed to assess risk factors associated with 5-year mortality.
RESULTS: A total of 464 patients were included in this study. The mean age was 65 years, and mean body mass index was 27 kg/m2. The majority of patients were male (68%), White (56%), diabetic (62%), and hypertensive (76%), and underwent below-the-knee amputation (69%). Prosthetic attainment occurred in 185 (40%). On multivariable analysis, age >81 years and current tobacco use were associated with no prosthetic fitting. Overall 5-year survival was 41.9% (95% confidence interval [CI], 37.6%-46.6%) (below-the-knee amputation, 47.7% [95% CI, 42.5%-53.5%]; above-the-knee amputation, 28.7% [95% CI, 22.1%-37.2%]). On multivariable analysis, age >60 years, congestive heart failure, above-the-knee amputation, and no prosthetic attainment were associated with decreased survival. Increasing K level was incrementally associated with improved survival.
CONCLUSIONS: This study has identified several patient factors associated with prosthetic attainment, as well as multiple factors predictive of reduced survival after amputation. Being referred for prosthetic fitting was associated with improved survival not explained by patient characteristics and comorbidities. The Medicare Functional Classification Level K level predicts survival. More research is needed to determine the barriers to prosthetic attainment and if improving a patients K level will improve survival.