Objectives Major and minor amputations are associated with significant rates of mortality. However, little is known about the impact of unplanned redo-amputation during the same hospitalization on outcomes. The objectives of this study were to identify the risk factors associated with in-hospital mortality after both major and minor amputations as well as the results of unplanned redo-amputation on outcome. Methods Retrospective study of 342 consecutive patients who were treated with lower extremity amputation in Brazil between January 2013 and October 2014. Results The in-hospital mortality rate was higher in major compared to minor amputation (25.6% vs. 4.1%; p < 0.0001). Whereas chronic kidney disease, chronic obstructive pulmonary disease, and planned staged amputation predicted in-hospital mortality after major amputation, age, and congestive heart failure predicted mortality after minor amputation. The white blood cell count predicted in-hospital mortality following both major and minor amputation. However, postoperative infection predicted in-hospital mortality only following major amputation. Conclusions In-hospital mortality was high after major amputations. Unplanned redo-amputation was not a predictor of in-hospital mortality after major or minor amputation. Planned staged amputation was associated with reduced survival after major but not minor amputation. Postoperative infection predicted mortality after major amputation. Systemic diseases and postoperative white blood cell were associated with in-hospital mortality. This study suggests a possible link between a pro-inflammatory state and increased in-hospital mortality following amputation.

Background:The time at which claudication symptoms are reported is used to modulate exercise intensity in clinical treatment of patients with peripheral arterial disease, but tissue oxygenation values at that point are unknown. Objective: To describe tissue oxygen supply measured using Near-Infrared Spectroscopy (NIRS) when patients report initial and maximum claudication symptoms during exercise tests. Methods: Nine patients (eight men) aged 65.63 ± 6.02 years and previously diagnosed with peripheral arterial disease performed constant load exercise testing and incremental load exercise testing while tissue oxygenation levels were monitored by NIRS. Oxygen saturation values at the times at which each patient reported initial onset of claudication symptoms and maximum claudication symptoms were compared with values obtained during the arterial occlusion maneuver, using the 95% confidence interval of the difference. Results: It was found that saturation values at the time of both initial and maximum claudication symptoms were statistically different from saturation during the arterial occlusion maneuver, but on the basis of percentage analysis they were similar from a clinical point of view. Conclusions: Oxygen saturations at the time patients report initial and maximum claudication symptoms are very close to saturations during arterial occlusion. From a clinical perspective, subjective patient report of symptoms is an appropriate parameter on which to base exercise prescription.

Resumo A desnutrição é uma doença extremamente prevalente em pacientes internados, chegando a acometer 50% deles, 47% dos pacientes cirúrgicos e entre 39 e 73% dos portadores de doença arterial periférica, com grande impacto na morbimortalidade desses pacientes. A desnutrição possui grande relevância no desfecho clínico desses pacientes durante a internação, estando associada a maior incidência de infecções, demora na cicatrização das feridas, diminuição do status de deambulação, maior tempo de internação e mortalidade. Entretanto, o diagnóstico de desnutrição ou risco nutricional desses pacientes tem sido um desafio. A avaliação nutricional subjetiva global revelou-se, até o momento, o padrão ouro como método de triagem de pacientes cirúrgicos internados devido à sua praticidade e acurácia. O objetivo deste trabalho é revisar métodos utilizados na avaliação do estado nutricional e da triagem nutricional de pacientes internados e caracterizar a importância dessa avaliação nos desfechos clínicos dos pacientes com arteriopatias.

&lt;LEAP&gt; Highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medication, surgery, education, nutrition, and exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature. Each article in this Physical Therapy (PTJ) series will summarize a Cochrane review or other scientific evidence resource on a single topic and will present clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on the effectiveness of supervised exercise therapy for intermittent claudication. Can supervised exercise therapy help a person with intermittent claudication?