Increased Mortality After Lower Extremity Amputation in a Danish Nationwide Cohort: The Mediating Role of Postoperative Complications.

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2025-01-25 eCollection Date: 2025-01-01 DOI:10.2147/CLEP.S499167

Anna Trier Heiberg Brix, Tanja Gram Petersen, Tine Nymark, Hagen Schmal, Martin Lindberg-Larsen, Katrine Hass Rubin

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引用次数: 0

Abstract

Objective: Patients who undergo major lower extremity amputation (MLEA) have the highest postoperative mortality among orthopedic patient groups. The comorbidity profile for MLEA patients is often extensive and associated with elevated postoperative mortality. This study primarily aimed to investigate the increased short- and long-term mortality following first and subsequent major lower extremity amputation. Secondarily, to examine the mediation role of post-amputation complications.

Study design and setting: With data from the Danish National Patient Registry, 11,695 first-time MLEAs in patients aged ≥50 years were identified between January 1, 2010, and December 31, 2021, along with 58,466 unamputated persons matched 1:5 by year of birth, sex, and region of residence. Mediators were identified through diagnosis codes (ICD-10) present in 6 months following MLEA.

Results: The increased mortality following MLEA was highest in the month following MLEA, hazard ratio (HR) 38.7 (95% confidence interval (CI) 30.5-48.9) in women and HR 55.7 (CI 44.3-70.2) in men compared to a matched unamputated cohort. Subsequent amputation resulted in an increased mortality the month after a subsequent amputation (overall HR 3.2 (CI 2.8-3.7) in women and HR 3.2 (CI 2.8-3.6) in men) and almost normalized after the first year. The proportion of the mortality risk that potentially could be reduced by preventing sepsis was 16% (CI 11.7-20.3) for women and 17% (CI 13.4-20.4) for men. For pneumonia, it was 10.5% (CI 7.1-13.9) in women and 14.9% (11.6-18.2) in men.

Conclusion: We observed an increased mortality in the month following MLEA, which remained elevated for years compared to the matched unamputated cohort. A subsequent amputation results in increased mortality in the following year, but declined and normalized after the first year. Sepsis and pneumonia arising after the amputation appeared to be important factors that contributed to the increased postoperative mortality.

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丹麦全国队列中下肢截肢后死亡率增加：术后并发症的中介作用。

目的：在骨科患者群体中，下肢大截肢（MLEA）患者术后死亡率最高。MLEA患者的合并症通常很广泛，并与术后死亡率升高有关。本研究的主要目的是调查首次和随后的下肢主要截肢后增加的短期和长期死亡率。其次，探讨截肢后并发症的中介作用。研究设计和背景：根据丹麦国家患者登记处的数据，在2010年1月1日至2021年12月31日期间，确定了11,695名≥50岁患者的首次mlea，以及58,466名未截肢者，按出生年份、性别和居住地区匹配1:5。通过MLEA后6个月内存在的诊断代码（ICD-10）确定介质。结果：与匹配的未截肢队列相比，MLEA后的死亡率增加在MLEA后的一个月内最高，女性的风险比（HR）为38.7(95%可信区间（CI） 30.5-48.9)，男性的风险比（HR）为55.7 （CI 44.3-70.2）。后续截肢导致后续截肢后一个月的死亡率增加(女性总HR 3.2 (CI 2.8-3.7)，男性HR 3.2 (CI 2.8-3.6))，一年后几乎正常化。预防败血症可能降低的死亡风险比例，女性为16% (CI 11.7-20.3)，男性为17% （CI 13.4-20.4）。对于肺炎，女性为10.5% (CI 7.1-13.9)，男性为14.9% （CI 11.6-18.2）。结论：我们观察到MLEA后一个月的死亡率增加，与匹配的未截肢队列相比，死亡率多年来保持升高。随后的截肢导致第二年死亡率增加，但在第一年后下降并恢复正常。截肢后出现的脓毒症和肺炎似乎是导致术后死亡率增加的重要因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.