Prosthetic Outcomes after Amputation and the Impact of Mobility Level on Survival.
Journal
Journal of vascular surgery
ISSN: 1097-6809
Titre abrégé: J Vasc Surg
Pays: United States
ID NLM: 8407742
Informations de publication
Date de publication:
24 Apr 2024
24 Apr 2024
Historique:
received:
07
03
2024
revised:
08
04
2024
accepted:
13
04
2024
medline:
27
4
2024
pubmed:
27
4
2024
entrez:
26
4
2024
Statut:
aheadofprint
Résumé
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. 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 (BMI), comorbidities, American Society of Anesthesiologists (ASA) score, statin use, level of amputation, stump revision, fitting for prosthesis, type of prosthesis, and the United States' Medicare Functional Classification Level (MFCL) 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. 464 patients were included in this study. The mean age was 65 years and mean body mass index 27 kg/m 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 MFCL 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.
Sections du résumé
BACKGROUND
BACKGROUND
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
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 (BMI), comorbidities, American Society of Anesthesiologists (ASA) score, statin use, level of amputation, stump revision, fitting for prosthesis, type of prosthesis, and the United States' Medicare Functional Classification Level (MFCL) 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
RESULTS
464 patients were included in this study. The mean age was 65 years and mean body mass index 27 kg/m
CONCLUSION
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 MFCL 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.
Identifiants
pubmed: 38670323
pii: S0741-5214(24)01071-1
doi: 10.1016/j.jvs.2024.04.046
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.