与紧急截肢状态相关的因素及其对死亡率的影响
Jayne R Rice1, Kara A Rothenberg1, Omar I Ramadan1
1Department of Vascular Surgery and Endovascular Therapy, Hospital of University of Pennsylvania, Philadelphia, PA.
Annals of vascular surgery
|April 6, 2024
概括
紧急的下肢截肢,通常在非白人和没有保险的患者身上进行,导致更高的并发症和死亡率. 解决护理差异对于改善截肢手术的结果至关重要.
科学领域:
- 血管外科 血管外科
- 健康差异 在健康上的差异
- 研究成果 研究成果 研究成果
背景情况:
- 与可选手术相比,紧急的下肢切断的30天死亡率明显高于紧急的下肢切断.
- 识别与紧急截肢相关的因素对于理解和改善术后和长期结果至关重要.
研究的目的:
- 确定与紧急下肢截肢相关的因素.
- 检查紧急截肢对术后并发症和长期死亡率的影响.
主要方法:
- 在血管质量倡议中,分析了从2013年到2020年接受主要下肢截肢的12874名患者.
- 紧急截肢被定义为在入院72小时内发生的截肢.
- 用单变量和多变量逻辑回归比较社会人口统计学特征,并发症和结果,通过Kaplan-Meier分析长期存活率.
主要成果:
- 紧急截肢 (37.7%) 在非白人患者,医疗补助/自付个人以及美国麻醉学会 (ASA) 4-5级较高患者中更为常见.
- 紧急截肢的原因包括不受控制的感染和急性肢体缺血.
- 紧急截肢与更高的术后并发症 (34.7%对比16.6%),住院患者死亡率 (8.9%对比5.4%) 和长期死亡率增加 (OR 1.24) 相联系.
结论:
- 紧急截肢与获得护理的显著差异有关,影响非白人,无保险者和不那么复杂的人群.
- 截肢的紧急性是术后并发症增加和长期死亡率的预测因素.
- 减少这些差异的有针对性的努力对于改善主要下肢截肢后的患者结果至关重要.
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