Major Lower Extremity Amputation

Aulivola, Bernadette

doi:10.1001/archsurg.139.4.395

Cited by 430 publications

(145 citation statements)

References 18 publications

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“…[1][2][3][4][5][6][7] Patient's pre-operative condition, including their ASA status, presence of septic shock and site of amputation undertaken are significant predictors of post-operative in hospital mortality rate and ICU admission rate. Patients with pre-operative septic shock, ASA 4 status and undergoing AKA should be regarding as high risk group, and appropriate level of intra-operative monitoring and post-operative disposition should be arranged.…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] With the increasing incidence of diabetes mellitus in Asia, the incidence of MLEA surgeries is set to increase over the next few years [8][9][10] as diabetes is one of the major risk factors for critical limb ischaemia and lower limb amputation surgeries. 10 It is important to identify factors that affects outcome in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have found the 30-day mortality rate for this group of patients to be ranging from 7-23%. [1][2][3][4][5][6][7] Patients undergoing these operations often have significant multiple comorbidities 4 and pre-operative hemodynamic disturbances, putting them at high risk both for surgery and for the further hemodynamic changes associated with anaesthesia. Most studies evaluating factors associated with peri-operative mortality rates in this group of patients are conducted in Caucasian populations, [3][4][5][6] and we find a lack of similar studies evaluating these factors in the Asian population.…”

Section: Introductionmentioning

confidence: 99%

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Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore

Teng¹,

Yi²,

Yong³

et al. 2017

Anesthesiol Open J

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Background: Non-traumatic Major Lower Extremity Amputation (MLEA) surgeries are associated with high post-operative morbidity and mortality rates. There are few studies evaluating factors associated with post-operative mortality rates for MLEA among Asian patients. Objective: To identify factors that affect post-operative mortality rate and ICU admission rates in patients undergoing non-traumatic MLEA surgeries in a tertiary institution in Singapore. Method: A retrospective study was performed by using the operating theatre electronic database to identify patients who underwent non-traumatic MLEA surgeries in Singapore General Hospital during the period of January 1, 2010 to December 31, 2011. Results: Data was collected from 186 non-traumatic MLEA surgeries performed during the study period. Overall post-operative in hospital mortality rate was 8.6%, higher for above knee amputation (AKA), than Through Knee Amputation (TKA) than Below Knee Amputation (BKA) (18.4% vs. 8% vs. 4.5%, p=0.015). In multivariate logistic regression analysis, site of amputation of AKA compared to BKA (odds ratio 3.9, 95% confidence interval 1.1-14.5, p=0.04), ASA 4 status (odds ratio 4.3, 95% confidence interval 1.2-14.6, p=0.02) and presence of septic shock (odds ratio 4.9, 95% confidence interval 1.4-17.3, p=0.01) were significant predictors of post-operative in hospital mortality rate. The same 3 factors were significant predictors of post-operative ICU admission rate. Use of peripheral nerve block as the sole anaesthetic technique did not affect in-hospital mortality rate (adjusted odds ratio 1.3, 95% confidence interval 0.3-5.6). Conclusion: Patients with ASA 4 status and pre-operative septic shock, especially those undergoing AKA, should be considered as high risk group and therefore managed appropriately. The higher incidence of post-operative ICU admission rate in this group of patients also necessitates pre-operative organization of bed availability. Using peripheral nerve block as the sole anaesthetic technique did not significantly affect outcomes measured.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore

Teng¹,

Yi²,

Yong³

et al. 2017

Anesthesiol Open J

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“…The number of patient records in these historical cohort studies was large (n = 174 to n = 21,520) [1][2]4,6,[8][9][10][11]30].…”

Section: Discussionmentioning

confidence: 99%

“…From historical cohort studies the patient survival rate after a lower-limb amputation because of vascular problems is clearly moderate to low over time [1][2][3][4][5][6][7][8][9][10][11][12]. However, prospective studies on lower-limb amputees seldom report their survival rates, inclusion and exclusion criteria, and/or referral and dropout rates (death included) [13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Survival of participating and nonparticipating limb amputees in prospective study: Consequences for research

Bosmans¹,

Geertzen²,

Hoekstra³

et al. 2010

JRRD

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Abstract-This study quantified selection by analyzing the survival rate of the participants and nonparticipants in a 4-year prospective, multicenter cohort study. In addition, the differences between these groups were analyzed. Surgeons of six hospitals in the northern Netherlands referred, in total, 225 patients to the study. Of these patients, 60% (n = 134) participated in the prospective study by filling in questionnaires; the others (nonparticipants) were followed over time through their records. No significant differences were found in sex and level of amputation between participants and nonparticipants; however, of the two groups, nonparticipants were significantly older. Reason for amputation was peripheral vascular disease (PVD) for 67% (n = 90) of the participants and 82% (n = 75) of the nonparticipants. The mean survival time of the participants and nonparticipants was 36.1 and 29.6 months, respectively. Within PVD, the mean survival time of participants and nonparticipants was 34.4 and 27.6 months, respectively. To summarize, our article gives an overview of the survival rates in a prospective study on patients scheduled for a limb amputation. Our study sample was biased by selection and death. Participants were generally healthier than nonparticipants.

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Through-knee versus above-knee amputation for vascular and non-vascular major lower limb amputations

Crane

Boam

Carradice

et al. 2021

Cochrane Database of Systematic Reviews

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Major Lower Extremity Amputation

Cited by 430 publications

References 18 publications

Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore

Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore

Survival of participating and nonparticipating limb amputees in prospective study: Consequences for research

Through-knee versus above-knee amputation for vascular and non-vascular major lower limb amputations

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