Wound Complications and Reoperations after Transtibial Amputation of the Leg.
Aged
Amputation, Surgical
/ adverse effects
Female
Humans
Intermittent Claudication
/ diagnosis
Ischemia
/ diagnosis
Leg
/ blood supply
Male
Middle Aged
Patient Care Bundles
Peripheral Arterial Disease
/ diagnosis
Regional Blood Flow
Reoperation
Retrospective Studies
Risk Factors
Surgical Wound Infection
/ diagnosis
Tibia
/ surgery
Time Factors
Treatment Outcome
Wound Healing
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
23
02
2020
revised:
30
04
2020
accepted:
09
05
2020
pubmed:
1
6
2020
medline:
1
12
2020
entrez:
1
6
2020
Statut:
ppublish
Résumé
Transtibial amputations (TTAs) of the leg have been associated with high rates of wound complications. We assessed outcomes of TTAs to determine if bundled interventions implemented at our hospital had an impact on lowering wound complications, including surgical site infections. We assessed the impact of a surgical site infection prevention bundle (negative-pressure wound therapy, minimizing the use of staples, and a decontamination protocol for methicillin-resistant Staphylococcus aureus) on 90-day wound complications. The year of implementation of the prevention bundle was excluded, and the pre-eras and posteras were defined as the four-year period before and after implementation. The study sample consisted of a single-center cohort, with TTA cases identified using operating room scheduling software. A total of 182 TTAs were performed: 110 in the pre-era and 72 in the postera. The wound complication rate decreased from 22 to 17% despite fewer two-stage operations, less imaging to identify peripheral artery disease, and an increased proportion of patients with end-stage renal disease. Wound complications and revision to a higher level of amputation were more associated with indication (especially no-option peripheral artery disease with ischemic rest pains) than with any particular aspect of surgical technique. The use of drains was associated with reoperations but not higher level revision. Higher rates of wound complications and revision to a higher level of amputations should be expected among patients with no-option peripheral artery disease with ischemic rest pains undergoing TTAs. Drains should be avoided.
Sections du résumé
BACKGROUND
BACKGROUND
Transtibial amputations (TTAs) of the leg have been associated with high rates of wound complications. We assessed outcomes of TTAs to determine if bundled interventions implemented at our hospital had an impact on lowering wound complications, including surgical site infections.
METHODS
METHODS
We assessed the impact of a surgical site infection prevention bundle (negative-pressure wound therapy, minimizing the use of staples, and a decontamination protocol for methicillin-resistant Staphylococcus aureus) on 90-day wound complications. The year of implementation of the prevention bundle was excluded, and the pre-eras and posteras were defined as the four-year period before and after implementation. The study sample consisted of a single-center cohort, with TTA cases identified using operating room scheduling software.
RESULTS
RESULTS
A total of 182 TTAs were performed: 110 in the pre-era and 72 in the postera. The wound complication rate decreased from 22 to 17% despite fewer two-stage operations, less imaging to identify peripheral artery disease, and an increased proportion of patients with end-stage renal disease. Wound complications and revision to a higher level of amputation were more associated with indication (especially no-option peripheral artery disease with ischemic rest pains) than with any particular aspect of surgical technique. The use of drains was associated with reoperations but not higher level revision.
CONCLUSIONS
CONCLUSIONS
Higher rates of wound complications and revision to a higher level of amputations should be expected among patients with no-option peripheral artery disease with ischemic rest pains undergoing TTAs. Drains should be avoided.
Identifiants
pubmed: 32474142
pii: S0890-5096(20)30430-1
doi: 10.1016/j.avsg.2020.05.023
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
292-297Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.