Short-term Mortality, Morbidity and Recovery Milestones after Major Lower Limb Amputation: a Prospective Evaluation of Outcomes in a Tertiary Center.
Aged
Amputation, Surgical
/ adverse effects
Amputees
/ psychology
Databases, Factual
England
Female
Health Status
Humans
Length of Stay
Leukocyte Count
Lower Extremity
/ surgery
Male
Mental Health
Middle Aged
Patient Discharge
Prospective Studies
Recovery of Function
Risk Factors
Social Behavior
Tertiary Care Centers
Time Factors
Treatment Outcome
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
29
03
2018
revised:
07
07
2018
accepted:
30
07
2018
pubmed:
21
10
2018
medline:
14
6
2019
entrez:
21
10
2018
Statut:
ppublish
Résumé
Major lower limb amputation (MLLA) is well recognized to carry a high rate of mortality; however, little evidence explores the reasons for this. Even fewer studies look at other outcomes after MLLA such as major morbidity and functional and social recovery. This study aims to provide a contemporary analysis of these outcomes to contextualize the current state of care for MLLA in the United Kingdom. All index MLLAs conducted in a single tertiary vascular center over a 1-year period were entered into the study. Data including demographic details, preoperative biochemical markers, and functional and social status were collected by a multidisciplinary team . Postoperative functional recovery milestones, and mortality and major morbidity data were collected prospectively from the date of amputation. Descriptive, univariate and multivariate analysis was used to present the results. Seventy-nine amputations were performed. The median total length of stay was 28.0 days (interquartile range [IQR] 14.0-48.0), and postoperative length was 18.0 days (IQR 9.5-36.0). Thirty-day mortality was 5.1% (n = 4), and 90-day mortality was 8.9% (n = 7). Thirty-day major morbidity was 32.4% (n = 24). After controlling for age and gender, preoperative serum white cell count was an independent predictor of 30-day mortality (odds ratio [OR] 1.375 [95% confidence interval [CI] 1.080-1.751]), 90-day mortality (OR 1.258 [95% CI 1.078-1.469]), and 30-day major morbidity (OR 1.228 [95% CI 1.070-1.409]. The proportion of the population living independently reduced from 56.7% to 13.7%, with 23.3% requiring further rehabilitation. The number needing either social care at home or permanent care placement rose by 12.8%. MLLA carries clinically significant risk of short-term mortality and morbidity. The only factor found to be consistently influential was preoperative serum white cell count. MLLA requires a significant in-hospital stay, and there is a significant deterioration in functional and social status after discharge from hospital.
Sections du résumé
BACKGROUND
BACKGROUND
Major lower limb amputation (MLLA) is well recognized to carry a high rate of mortality; however, little evidence explores the reasons for this. Even fewer studies look at other outcomes after MLLA such as major morbidity and functional and social recovery. This study aims to provide a contemporary analysis of these outcomes to contextualize the current state of care for MLLA in the United Kingdom.
METHODS
METHODS
All index MLLAs conducted in a single tertiary vascular center over a 1-year period were entered into the study. Data including demographic details, preoperative biochemical markers, and functional and social status were collected by a multidisciplinary team . Postoperative functional recovery milestones, and mortality and major morbidity data were collected prospectively from the date of amputation. Descriptive, univariate and multivariate analysis was used to present the results.
RESULTS
RESULTS
Seventy-nine amputations were performed. The median total length of stay was 28.0 days (interquartile range [IQR] 14.0-48.0), and postoperative length was 18.0 days (IQR 9.5-36.0). Thirty-day mortality was 5.1% (n = 4), and 90-day mortality was 8.9% (n = 7). Thirty-day major morbidity was 32.4% (n = 24). After controlling for age and gender, preoperative serum white cell count was an independent predictor of 30-day mortality (odds ratio [OR] 1.375 [95% confidence interval [CI] 1.080-1.751]), 90-day mortality (OR 1.258 [95% CI 1.078-1.469]), and 30-day major morbidity (OR 1.228 [95% CI 1.070-1.409]. The proportion of the population living independently reduced from 56.7% to 13.7%, with 23.3% requiring further rehabilitation. The number needing either social care at home or permanent care placement rose by 12.8%.
CONCLUSIONS
CONCLUSIONS
MLLA carries clinically significant risk of short-term mortality and morbidity. The only factor found to be consistently influential was preoperative serum white cell count. MLLA requires a significant in-hospital stay, and there is a significant deterioration in functional and social status after discharge from hospital.
Identifiants
pubmed: 30342210
pii: S0890-5096(18)30811-2
doi: 10.1016/j.avsg.2018.07.070
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
261-273Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.