Risks and Risk Factors for Ipsilateral Re-Amputation in the First Year Following First Major Unilateral Dysvascular Amputation

摘要: Objective To identify timing, incidence, and risk factors for ipsilateral re-amputation within 12 months of first dysvascular amputation to determine specific subgroups patients at each level that are increased risk. Methods A retrospective cohort study evaluating 7187 with unilateral transmetatarsal (TM), transtibial (TT), or transfemoral (TF) secondary diabetes and/or peripheral artery disease (PAD) were identified in the VA Surgical Quality Improvement Program database between 2004 2014. Re-amputation was defined as any subsequent soft tissue/bony revision a higher level. Twenty-three potential pre-operative (and nine interactions) identified. backward stepwise Cox regression used factors. Incidence rates hazard ratios (HR) 95% confidence intervals (CI) computed. Results The median time highest year 33 (interquartile range, 13–73) days. Risk requiring least one 41% 25% 9% (TF). associated included chronic obstructive pulmonary disease, elevated white blood cell count, abnormal ankle brachial index (ABI), history revascularisation, alcohol misuse. TM who had only (HR 1.9; CI 1.4–2.5), an (ABI) score 2.4; 1.8–3.2), kidney failure 1.7; 1.3–2.1) greatest re-amputation. TT amputees smokers also 1.4; 1.2–1.6). Conclusion This research important primary healing need If considering amputation, caution should be exercised diabetes, particular those ABI renal failure. At level, smoke.