Factors Affecting Perioperative Mortality and Wound-Related Complications Following Major Lower Extremity Amputations

Stone, Patrick A.; Flaherty, Sarah K.; AbuRahma, Ali F.; Hass, Stephen M.; Jackson, Jacob; Hayes, John D.; Hofeldt, Matthew J.; Hager, Casey S.; Elmore, Michael

doi:10.1007/s10016-006-9009-z

Cited by 93 publications

(86 citation statements)

References 26 publications

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“…The remaining factors associated with worsened long-term outcome correspond with published literature. Several authors have identified increased ASA grade as a risk factor for increased peri-operative [4,[12][13][14] and longterm morbidity after amputation [6]. Increasing age has also been associated with worse long-term outcome in previous studies [4,6,12].…”

Section: Discussionmentioning

confidence: 99%

Factors influencing short‐ and long‐term mortality after lower limb amputation

et al. 2014

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SummaryMortality after lower limb amputation is high, with UK 30-day mortality rates of 9-17%. We performed a retrospective analysis of factors affecting early and late outcome after lower limb amputation for peripheral vascular disease or diabetic complications at a UK tertiary referral vascular centre between 2003 and 2010. Three hundred and thirty-nine patients (233 male), of median (IQR [range]) age 73 (62-79 [26-92]) years underwent amputation. Thirty-day mortality was 12.4%. On regression modelling, the risk of 30-day mortality was increased in patients of ASA grade ≥ 4 (OR 4.23, 95% CI 2.07-8.63), p < 0.001 and age between 74 and 79 years (OR 3.8, 95% CI 1.10-13.13), p = 0.04 and older than 79 years (OR 4.08, 95% CI 1.25-13.25), p = 0.02. Peri-operative (30-day) mortality for these groups was 23.2%, 13.7% and 18.8%, respectively. Survival and Cox regression analysis demonstrated that long-term mortality was associated with: age 74-79 years (HR 2.15, 95% CI 1.38-3.35), p = 0.001; age > 79 years (HR 2.78, 95% CI 1.82-4.25), p < 0.001; ASA grade ≥ 4 (HR 2.04, 95% CI 1.51-2.75), p < 0.001; out-of-hours operating (HR 1.51, 95% CI 1.08-2.10), p = 0.02; and chronic kidney disease stage 4-5 (1.57, 95% CI 1.07-2.30), p = 0.02. Anaesthetic technique was associated with long-term mortality on survival analysis (p = 0.04), but not when analysed using regression modelling. Mortality after lower limb amputation relates to patient age, ASA, out-of-hours surgery and renal dysfunction. These data support lower limb amputations' being performed during daytime hours and after modification of correctable risk factors.

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Section: Discussionmentioning

confidence: 99%

Factors influencing short‐ and long‐term mortality after lower limb amputation

et al. 2014

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“…[1][2][3][4][5][6][7] Patient's pre-operative condition, including their ASA status, presence of septic shock and site of amputation undertaken are significant predictors of post-operative in hospital mortality rate and ICU admission rate. Patients with pre-operative septic shock, ASA 4 status and undergoing AKA should be regarding as high risk group, and appropriate level of intra-operative monitoring and post-operative disposition should be arranged.…”

Section: Resultsmentioning

confidence: 99%

“…Firstly, pre-operative septic shock, ASA 4 status and site of amputation of AKA are significant predictors of higher post-operative in hospital mortality rate and ICU admission. Previous studies evaluating non-traumatic MLEA found thatage, 6 albumin level, 6 AKA, 4,6 lack of a previous coronary artery bypass graft, 6 renal insufficiency, 4 ASA grade ≥4 12 and out-of-hours surgery 12 are factors that affect peri-operative mortality rate. This knowledge is important when risk stratifying patients before surgery.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] With the increasing incidence of diabetes mellitus in Asia, the incidence of MLEA surgeries is set to increase over the next few years [8][9][10] as diabetes is one of the major risk factors for critical limb ischaemia and lower limb amputation surgeries. 10 It is important to identify factors that affects outcome in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have found the 30-day mortality rate for this group of patients to be ranging from 7-23%. [1][2][3][4][5][6][7] Patients undergoing these operations often have significant multiple comorbidities 4 and pre-operative hemodynamic disturbances, putting them at high risk both for surgery and for the further hemodynamic changes associated with anaesthesia. Most studies evaluating factors associated with peri-operative mortality rates in this group of patients are conducted in Caucasian populations, [3][4][5][6] and we find a lack of similar studies evaluating these factors in the Asian population.…”

Section: Introductionmentioning

confidence: 99%

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Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore

Teng¹,

Yi²,

Yong³

et al. 2017

Anesthesiol Open J

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Background: Non-traumatic Major Lower Extremity Amputation (MLEA) surgeries are associated with high post-operative morbidity and mortality rates. There are few studies evaluating factors associated with post-operative mortality rates for MLEA among Asian patients. Objective: To identify factors that affect post-operative mortality rate and ICU admission rates in patients undergoing non-traumatic MLEA surgeries in a tertiary institution in Singapore. Method: A retrospective study was performed by using the operating theatre electronic database to identify patients who underwent non-traumatic MLEA surgeries in Singapore General Hospital during the period of January 1, 2010 to December 31, 2011. Results: Data was collected from 186 non-traumatic MLEA surgeries performed during the study period. Overall post-operative in hospital mortality rate was 8.6%, higher for above knee amputation (AKA), than Through Knee Amputation (TKA) than Below Knee Amputation (BKA) (18.4% vs. 8% vs. 4.5%, p=0.015). In multivariate logistic regression analysis, site of amputation of AKA compared to BKA (odds ratio 3.9, 95% confidence interval 1.1-14.5, p=0.04), ASA 4 status (odds ratio 4.3, 95% confidence interval 1.2-14.6, p=0.02) and presence of septic shock (odds ratio 4.9, 95% confidence interval 1.4-17.3, p=0.01) were significant predictors of post-operative in hospital mortality rate. The same 3 factors were significant predictors of post-operative ICU admission rate. Use of peripheral nerve block as the sole anaesthetic technique did not affect in-hospital mortality rate (adjusted odds ratio 1.3, 95% confidence interval 0.3-5.6). Conclusion: Patients with ASA 4 status and pre-operative septic shock, especially those undergoing AKA, should be considered as high risk group and therefore managed appropriately. The higher incidence of post-operative ICU admission rate in this group of patients also necessitates pre-operative organization of bed availability. Using peripheral nerve block as the sole anaesthetic technique did not significantly affect outcomes measured.

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Factors Affecting Perioperative Mortality and Wound-Related Complications Following Major Lower Extremity Amputations

Cited by 93 publications

References 26 publications

Factors influencing short‐ and long‐term mortality after lower limb amputation

Factors influencing short‐ and long‐term mortality after lower limb amputation

Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore

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