Comparing perioperative outcomes after transmetatarsal amputation in patients with or without peripheral vascular disease.

IF 2.5 3区 医学 Q1 ORTHOPEDICS
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.

有或无周围血管疾病患者经跖骨截肢围手术期疗效的比较。
背景:经跖骨截肢(TMA)是一种常见的手术坏疽设置糖尿病或周围血管疾病。本研究的目的是探讨感染性/糖尿病性创伤与周围血管疾病患者手术后TMA再手术和围手术期并发症的发生率和危险因素。方法:2015年1月1日至2020年12月31日期间接受TMA的患者使用美国外科医师学会国家手术质量改进计划数据库进行识别。手术指征采用国际疾病分类9/10编码报告。患者分为两组:主要因感染性/糖尿病性伤口接受手术的患者和周围血管疾病接受手术的患者。报告了30天死亡率、再入院、再手术、非家庭出院以及各种内科和外科并发症的发生率。比较糖尿病组和周围血管疾病组的预后指标。使用逻辑回归来确定每个感兴趣的结果测量的独立危险因素。结果:3392例患者被纳入最终队列。30天死亡率2.9%,再手术率13.8%,再入院率16.8%,手术并发症率22.2%,内科并发症率15.8%。接受血管指征手术的患者死亡率、再手术率、再住院率、非家庭出院率和各种医疗并发症的发生率较高(p结论:TMA后报告了显著的死亡率、再手术率和再住院率。周围血管疾病的存在与再手术和医疗并发症独立相关。接受TMA的患者,特别是外周血管疾病患者,应被告知围手术期风险,并仔细指示手术。
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来源期刊
CiteScore
4.50
自引率
10.30%
发文量
83
审稿时长
>12 weeks
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.
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