No abstract

Thirty-day mortality rates following major lower extremity amputations (LEAs) have declined from 22% in the late 1990s and early 2000s 1,2 to less than 7% by 2007. [3][4][5] Yet reported 5-year mortality rates in the literature have remained high, ranging from 40.4% 6 to 70%, 7 and major LEA, particularly above the knee amputation (AKA), continues to be cited as a significant predictor of mortality. 2,8 However, the majority of the literature supporting these rates is relatively old and may not reflect recent advances in medical disease management, perioperative and postoperative support, and advanced rehabilitative care. In older literature, the leading causes of death were pulmonary embolism and sepsis, suggesting that lack of mobility and postoperative complications were the major contributors to high mortality rates. 9 More recently, common ReconstructiveORiginal aRticle Background: Mortality rates following major lower extremity amputations (LEAs) 30 days-365 days postoperative have decreased, but 5-year rates remain high at 40.4%-70%. These data may not reflect recent advances in peripheral arterial disease (PAD) care, and comorbidities of chronic PAD may lead to mortality more frequently than the amputation itself. Mortality rates between diabetic and nondiabetic patients were also analyzed. Methods: The California Office of Statewide Health Planning and Development hospital database was queried for patients admitted January 1, 2007-December 31, 2018. ICD-9-CM codes identified patients with vascular disease and an amputation procedure.Results: There were 26,669 patients. The 30-day, 90-day, 1-year, and 5-year major LEA mortality rates were 4.82%, 8.62%, 12.47%, and 18.11%, respectively. Weighted averages of 30-day, 90-day, 1-year, and 5-year major LEA mortality rates in the literature are 13%, 15.40%, 47.93%, and 60.60%, respectively. Mortality risk associated with vascular disease after amputation (hazard ratio = 22.07) was 11 times greater than risk associated with amputation-specific complications from impaired mobility (hazard ratio = 1.90; P < 0.01). Having diabetes was associated with lower mortality at 30 days, 90 days, and 1 year (P < 0.01) but not at 5 years (P = 0.22). Conclusions: This study suggests that people may be living longer after their major LEA than was previously thought. This study suggests that patients' PAD may play a bigger role in contributing to their mortality than complications from loss of mobility postamputation. Although having diabetes was associated with lower postamputation mortality, the difference was no longer significant by 5 years.

No abstract

Purpose: Quality-of-life and patient-reported outcome measures have become a major focus of clinical and outcomes assessments. The purpose of this study was to develop a valid Patient Reported Outcome Measure for Vascular Malformation ("PROVAM") questionnaire to assess health-related quality of life in patients with vascular malformations (VAMs) before and after treatment. Materials and Methods: We developed and validated PRO-VAM using a mixed-methods design during an IRB-approved, prospective clinical trial at a VAM clinic. The pilot instrument consisted of 30 items (26 Likert-type response scale, 4 freeresponse) across domains including pain, social and emotional well-being, functional impact, and treatment. Functional impact items were specific to VAM anatomic location (head and neck or torso and extremities). Two items were included in the test battery to assess questionnaire relevance and ease of understanding. The questionnaire was implemented in the clinical setting from July 2019 to February 2020 to obtain evidence for reliability and construct validity of items and scales. To evaluate reliability, internal consistency was measured using Cronbach's alpha. Factor analysis, and convergent and discriminant validity testing were used to assess construct validity. Responsiveness was evaluated using patients with both pre-and post-treatment questionnaires, with the hypothesis that total score would decrease post-treatment. Results: 108 patients with VAM (median age 18 years; 58% female) completed a total of 130 questionnaires. All subscales including pain, emotional and social well-being, and functional impact, had Cronbach's alpha coefficients > ¼ 0.79. These dimensions were confirmed by factor analysis (P< 0.001). 25 of 26 Likert-type response questions were shown to be valid with good convergent and discriminant construct validity. In a subset of patients who completed PROVAM pre-and post-treatment (median follow up 10-weeks; n ¼ 13), there was a significant decrease in total score (P ¼ 0.036). Participants found survey questions easy to understand (median score 5 [IQR 4-5] on 5-point Likert-type scale) and relevant (median score 4 [IQR 3-5]). Conclusions: Preliminary data support the reliability, validity, and responsiveness of the 30-item PROVAM instrument to measure health-related quality of life in patients with VAMs.

No abstract