Mark A Plantz, Rachel Bergman, Erik Gerlach, Muhammad Mutawakkil, Milap Patel, Anish R Kadakia
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引用次数: 0
Abstract
Background: Transmetatarsal amputation (TMA) is a commonly performed procedure for gangrene in the setting of diabetes or peripheral vascular disease. The purpose of this study is to investigate the incidence of and risk factors for reoperation and perioperative complications after TMA in patients undergoing surgery for primarily infectious/diabetic wounds versus peripheral vascular disease.
Methods: Patients undergoing TMA between January 1, 2015 and December 31, 2020 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. The indication for surgery was reported using the International Classification of Disease 9/10 codes. Patients were categorized into two groups: patients undergoing surgery for primarily infectious/diabetic wounds versus peripheral vascular disease. The incidence of 30-day mortality, readmission, reoperation, nonhome discharge, and various medical and surgical complications was reported. Outcome measures were compared between the diabetic and peripheral vascular disease groups. Logistic regression was used to identify independent risk factors for each outcome measure of interest.
Results: 3392 patients were included in the final cohort. There was a 30-day mortality rate of 2.9%, reoperation rate of 13.8%, readmission rate of 16.8%, surgical complication rate of 22.2%, and medical complication rate of 15.8%. Patients undergoing surgery for a vascular indication had a higher rate of mortality, reoperation, hospital readmission, nonhome discharge, and various medical complications (p < 0.05). Patients undergoing surgery for infectious/diabetic wounds had a higher rate of deep surgical site infection and systemic sepsis (p < 0.05). A vascular surgical indication was independently associated with reoperation and overall medical complications (p < 0.05). Various factors, including age, body mass index, medical comorbidities, and the presence of preoperative sepsis were associated with poor outcomes.
Conclusion: Significant rates of mortality, reoperation, and hospital readmission were reported after TMA. The presence of peripheral vascular disease was independently associated with reoperation and medical complications. Patients undergoing TMA, particularly for peripheral vascular disease, should be counseled about perioperative risks and indicated for surgery carefully.
期刊介绍:
Journal of Foot and Ankle Research, the official journal of the Australian Podiatry Association and The College of Podiatry (UK), is an open access journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders.
Journal of Foot and Ankle Research covers a wide range of clinical subject areas, including diabetology, paediatrics, sports medicine, gerontology and geriatrics, foot surgery, physical therapy, dermatology, wound management, radiology, biomechanics and bioengineering, orthotics and prosthetics, as well the broad areas of epidemiology, policy, organisation and delivery of services related to foot and ankle care.
The journal encourages submissions from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care.
The Australian Podiatry Association and the College of Podiatry (UK) have reserve funds to cover the article-processing charge for manuscripts submitted by its members. Society members can email the appropriate contact at Australian Podiatry Association or The College of Podiatry to obtain the corresponding code to enter on submission.