在肥胖患者中延迟关闭指甲刀下肢截肢与增加的死亡率有关
Eyerusalem Workneh1, Allison Karwoski1, Natalie Chao1
1Vascular Division, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Annals of vascular surgery
|February 23, 2024
概括
在接受重大下肢截肢切断 (LEA) 的肥胖患者中,在8天内早期结束开放式指甲刀截肢切断 (OGA) 与改善生存率和降低死亡率有关. 这一发现凸显了OGA及时关闭对于更好的患者结果的重要性.
科学领域:
- 血管外科 血管外科
- 整形外科手术 整形外科手术
- 创伤外科 手术 创伤外科
背景情况:
- 阶段性手术涉及开放式指甲截肢 (OGA),随后是最终的主要下肢截肢 (LEA) 是一种公认的方法来控制败血症和伤口愈合.
- 虽然有效,但术后并发症和OGA关闭时间对患者结果的影响仍然需要进一步调查.
研究的目的:
- 评估OGA关闭时间 (TOC) 和主要下肢截肢 (LEA) 后患者结果之间的关联.
- 具体来说,要确定TOC是否会影响经过阶段性LEA的患者的死亡率,并发症和功能恢复.
主要方法:
- 追溯分析2015-2021年主要的LEA病例,包括膝下,透膝和膝上截肢.
- 在最终截肢之前接受分阶段OGA的患者被选中,不包括那些在关闭之前死亡的患者.
- 分析的结果包括手术部位感染,败血症,行走,停留时间和30天,1年和5年的死亡率. 接收器操作特征 (ROC) 曲线分析确定了最佳的TOC截止值,特别是在肥胖患者中.
主要成果:
- 在接受阶段性LEA的322名患者中,中位数TOC为4天 (范围为1-47天).
- 在肥胖患者 (n=199) 中,8天的最佳TOC预测了具有高灵敏度和特异性的死亡率 (AUC 0.709).
- 与较晚关闭的患者相比,TOC<8天的肥胖患者没有30天死亡率,1年死亡率明显降低,生存率改善,深静脉血栓症并发症较少.
结论:
- 到OGA关闭的时间是接受主要下肢截肢的肥胖患者死亡率的重要预测因素.
- 较早关闭OGA (少于8天) 与该患者群的生存率改善和死亡率降低有关.
- 这些发现强调了OGA及时关闭对于优化需要分阶段LEA的肥胖患者的结果至关重要.
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