Postoperative mortality after nontraumatic lower extremity amputation in patients with renal insufficiency.
نویسندگان
چکیده
Mortality rates after lower extremity amputation are extremely high among dialysis patients. However, the impact of milder degrees of renal insufficiency on death rates after lower extremity amputation has not been carefully examined. In this study, the authors used data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to measure the association between renal dysfunction and 30-d mortality after nontraumatic amputation adjusted for confounders. The study population consisted of 16,994 patients undergoing their first NSQIP recorded amputation from January 1, 1994 through September 30, 2001. Thirty-five percent of all cohort patients had at least moderate renal insufficiency, and 52% of all postoperative deaths occurred in this group. Postoperative mortality was 9% in patients with moderate renal insufficiency, 15% in patients with severe renal insufficiency, and 16% in dialysis patients, compared with 6% in patients with normal or mildly reduced renal function. Renal insufficiency remained associated with death after adjustment for confounders (adjusted odds ratio [OR] 3.36, 95% confidence interval [CI] 2.75 to 4.10 [dialysis patients]; OR 2.54, CI 2.06 to 3.14 [severe renal insufficiency]; and OR 1.52, CI 1.32 to 1.76 [moderate renal insufficiency]). In conclusion, even moderate renal insufficiency is independently associated with postoperative death after lower extremity amputation. This finding highlights the need for a targeted approach to improving the care of patients with renal insufficiency undergoing lower extremity amputation.
منابع مشابه
Improving the level of amputation of the lower extremity after therapeutic endovascular intervention for patients with critical limb ischemia
Methods: We conducted a comparative study of two groups of patients suffering from arterial insufficiency of the lower extremities, and the decision taken to amputate above the knee for both of them. A group of patients selected for a therapeutic peripheral intervention, and the effect of this intervention in improving the level of amputation studied and calculated statistically. The study cond...
متن کاملMortality following operations for lower extremity peripheral arterial disease
BACKGROUND We sought to identify risk factors associated with mortality following surgery for peripheral arterial disease (PAD). METHODS We evaluated the association between levels of control of atherosclerotic risk factors and time to mortality following either lower extremity bypass surgery or lower extremity amputation using Cox proportional hazards regression. RESULTS Among 796 patients...
متن کاملRenal insufficiency after infrarenal abdominal aortic aneurysm reconstruction: An analysis of this risk factor in 45 patients
Abstract Background: Renal insufficiency is a potential complication after infrarenal abdominal aortic aneurysm repair and is a significant risk factor for postoperative mortality and morbidity. The aim of this study was to analyze the effect of this risk factor, before and during operation. Methods: In this prospective study, between 2003 and 2006, 45 patients underwent repair of an infrarena...
متن کاملکیفیت زندگی و سرنوشت بیماران دیابتی دچار قطع عضو اندام تحتانی
Background and purpose: One of the major complications in diabetes mellitus is lower extremity amputation. Amputation can affect different aspect of patient’s life and cause various morbidities. The purpose of this study was to observe the effect of amputation on quality of life and determining the frequency and causes of mortality in these patients. Material and Methods: This study was perfor...
متن کاملRisk Factors for In-hospital Mortality and Reamputation Following Lower Limb Amputation
The backgrounds of patients undergoing lower limb amputation (LLA) have recently changed dramatically. From the 1970s to the 1990s, the main reason for LLA was traumatic injury.1–3) However, peripheral vascular disease (PVD) and diabetes mellitus (DM) have emerged as major causes of LLA. In recent studies, PVD and DM accounted for 61.0%–92.5% of LLAs.1–4) Previous studies have also reported hig...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Journal of the American Society of Nephrology : JASN
دوره 15 2 شماره
صفحات -
تاریخ انتشار 2004