组织损失类型与截肢风险之间的关联在Medicare患者中,患者同时患有糖尿病和外围动脉疾病
Aravind S Ponukumati1, Brianna M Krafcik2, Laura Newton3
1Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; VA Medical Center, White River Junction, VT.
Journal of vascular surgery
|June 16, 2024
概括
组织损失的严重程度是糖尿病和周围动脉疾病 (DM/PAD) 患者截肢风险的主要驱动因素. 炎显著增加截肢风险,强调需要及时的伤口护理和干预.
科学领域:
- 血管外科 血管外科
- 糖尿病学 糖尿病学
- 公共卫生 公共卫生
背景情况:
- 糖尿病和周围动脉疾病 (DM/PAD) 是下肢截肢的重要危险因素.
- 之前的研究已经确定了一般的风险因素,但组织损失严重程度对DM/PAD患者截肢风险的具体影响需要进一步阐明.
研究的目的:
- 量化DM/PAD患者不同类型和严重程度的组织损失和截肢风险之间的关联.
- 为了比较组织损失严重程度对人口,预防和社会经济因素对截肢风险的影响.
主要方法:
- 使用的医疗保险索赔数据 (2007-2019) 与ICD-9/10代码来识别患有DM/PAD的患者.
- 根据诊断代码,组织损失被分类为八种类型,从淋巴腺炎到炎.
- 采用考克斯的比例危险模型来评估1年和5年的截肢风险,以多个共同变量进行调整. 此外,还分析了区域差异.
主要成果:
- 鉴定了超过1200万患有DM/PAD的患者,18%的患者经历了组织损失.
- 截肢率在患有组织损失的患者中 (6.4%) 与没有 (0.4%) 的患者相比显著更高.
- 截肢风险随着组织损失的严重程度而急剧增加,从淋巴腺炎的两倍增加到瘤的29倍增加,超过了其他人口因素.
结论:
- 组织损失的存在和程度是DM/PAD患者截肢的最关键预测因素,超过了其他研究因素的影响.
- 组织损失是识别需要紧急干预措施的高风险个体的关键指标,如伤口护理,再血管化和感染管理.
- 在截肢率高的地区开发有针对性的护理系统对于减轻DM/PAD弱势群体截肢风险至关重要.
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