Efficacy of VBHOM to Predict Outcome Following Major Lower Limb Amputation

Patterson, Andrew J.; Degnan, Andrew J.; Walsh, Stewart R.; Eltayeb, Mohammed Ahmed; Scout, Earl F.; Clarke, J; Wilson, Y.G.; Tang, Tjun Yip

doi:10.1177/1538574412445600

Cited by 9 publications

(11 citation statements)

References 19 publications

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“…Although limited work exists for UK populations, the only large studies come from parts of the world with radically different healthcare systems, calling generalisability into question (Supplementary Table 1). [2][3][4][5][6][7] Mortality is not the only negative outcome experienced by this cohort; they face long hospital stays, a high rate of perioperative complications and frequent readmissions. 8 Prognostic risk modelling into leading causes of morbidity is therefore also important.…”

Section: Introductionmentioning

confidence: 90%

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Prognostic Risk Modelling for Patients Undergoing Major Lower Limb Amputation: An Analysis of the UK National Vascular Registry

Ambler

Thomas-Jones

Edwards

et al. 2020

European Journal of Vascular and Endovascular Surgery

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Eleven independent risk factors were identified including emergency admission, raised white cell count or creatinine, low albumin or patient weight, age, American Society of Anesthesiologists grade, amputation level and prior intervention to the amputated limb. A risk model was developed which had excellent calibration and good discrimination (Cstatistic 0.79, 95% C.I. 0.77-0.80). An on-line calculator for the model is available, making it easy to use.

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Section: Introductionmentioning

confidence: 90%

“…2,5,7 The revised Vascular Biochemistry and Haematology Outcome Model does not suffer from this problem, so comparison with this model can be viewed as 'fair'. 3 The Hosmer-Lemeshow goodness of fit test was used to assess calibration of the models. 21…”

Section: Ethical Approval and Study Registrationmentioning

confidence: 99%

Prognostic Risk Modelling for Patients Undergoing Major Lower Limb Amputation: An Analysis of the UK National Vascular Registry

Ambler

Thomas-Jones

Edwards

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…Patterson et al recently reported a risk model to predict outcome after amputation using the Vascular Biochemistry and Haematology Outcome Model, which incorporates a limited set of data collected before surgery [19]. They reported that in-hospital mortality was associated with low serum concentrations of albumin, haemoglobin and sodium, and with higher concentrations of urea, creatinine and potassium.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing short‐ and long‐term mortality after lower limb amputation

et al. 2014

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SummaryMortality after lower limb amputation is high, with UK 30-day mortality rates of 9-17%. We performed a retrospective analysis of factors affecting early and late outcome after lower limb amputation for peripheral vascular disease or diabetic complications at a UK tertiary referral vascular centre between 2003 and 2010. Three hundred and thirty-nine patients (233 male), of median (IQR [range]) age 73 (62-79 [26-92]) years underwent amputation. Thirty-day mortality was 12.4%. On regression modelling, the risk of 30-day mortality was increased in patients of ASA grade ≥ 4 (OR 4.23, 95% CI 2.07-8.63), p < 0.001 and age between 74 and 79 years (OR 3.8, 95% CI 1.10-13.13), p = 0.04 and older than 79 years (OR 4.08, 95% CI 1.25-13.25), p = 0.02. Peri-operative (30-day) mortality for these groups was 23.2%, 13.7% and 18.8%, respectively. Survival and Cox regression analysis demonstrated that long-term mortality was associated with: age 74-79 years (HR 2.15, 95% CI 1.38-3.35), p = 0.001; age > 79 years (HR 2.78, 95% CI 1.82-4.25), p < 0.001; ASA grade ≥ 4 (HR 2.04, 95% CI 1.51-2.75), p < 0.001; out-of-hours operating (HR 1.51, 95% CI 1.08-2.10), p = 0.02; and chronic kidney disease stage 4-5 (1.57, 95% CI 1.07-2.30), p = 0.02. Anaesthetic technique was associated with long-term mortality on survival analysis (p = 0.04), but not when analysed using regression modelling. Mortality after lower limb amputation relates to patient age, ASA, out-of-hours surgery and renal dysfunction. These data support lower limb amputations' being performed during daytime hours and after modification of correctable risk factors.

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“…Early mortality after major amputation has been shown to be significant, both in hospital and after discharge, 2,3 and 1-year mortality of up to 54% has been reported. 17 The 3-year mortality in the current series was 32%. This was not apparently related to the circumstances to which patients were discharged.…”

Section: Discussionmentioning

confidence: 61%

“…Care of leg amputees has been reported to be less than optimal in the developed world. 17 Care in the developing world would be expected to be sub-optimum following major lower extremity amputations. Reports from Africa dwell on peri-operative events and the lack of rehabilitation, as well as a different predominantly non-vascular aetiological spectrum, but do not address post-discharge circumstances.…”

Section: Discussionmentioning

confidence: 99%

Absence of effect of post-discharge socioeconomic circumstances on the outcome of dysvascular lower limb amputees: a prospective cohort study

Mathebula¹,

Karusseit²,

Mokoena³

2018

S. Afr. j. surg.

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Background: Significant mortality and morbidity occur after major lower limb amputation for diabetes-related foot complications and peripheral arterial disease. Risk factors for atherosclerosis and medical comorbidities are common in amputation for diabetes-related foot complications and are major determinants of outcome. Conversely, the effect of posthospitalisation circumstances on outcome has not been systematically studied. We hypothesised that poor socioeconomic circumstances after discharge would have an adverse effect on the outcome of major amputation in a developing country. Objectives: To determine the association of the status of post discharge socioeconomic circumstances on the outcome of dysvascular amputation. Methods: This was a prospective cohort study. Patients scheduled for major dysvascular lower limb amputation were recruited. Data were collected regarding the socioeconomic circumstances to which patients would be discharged, such as housing, income and personal care. Patients were followed up at our hospital, at clinics and later telephonically for three years. Mortality and wound morbidity were documented. Association of differences in status of socioeconomic factors and outcomes was analysed statistically. Results: Ninety nine patients were enrolled. Eight patients died in hospital and 91 were discharged. The socioeconomic circumstances of discharged patients were relatively favourable, the majority living in brick houses (92%) with running water (87%). Most patients had a regular income (86%), more than half had state/government grants. The availability of co-habitants, care givers and accessible medical facilities was also favourable. None of the different socioeconomic status levels demonstrated an effect on morbidity or mortality, all associations having a p-value greater than 0.05 (Chi-squared Fisher's exact and Spearman's rank correlation tests). Conclusion: No association between socioeconomic status factors and post-discharge outcome of amputees was demonstrated. This is probably because the dysvascular amputees in this study cohort were living in relatively favourable circumstances.

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Efficacy of VBHOM to Predict Outcome Following Major Lower Limb Amputation

Abstract: Our simplified model had good predictive ability and suggests redundancy in input variables used by the existing models.

Cited by 9 publications

References 19 publications

Prognostic Risk Modelling for Patients Undergoing Major Lower Limb Amputation: An Analysis of the UK National Vascular Registry

Prognostic Risk Modelling for Patients Undergoing Major Lower Limb Amputation: An Analysis of the UK National Vascular Registry

Factors influencing short‐ and long‐term mortality after lower limb amputation

Absence of effect of post-discharge socioeconomic circumstances on the outcome of dysvascular lower limb amputees: a prospective cohort study

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