足と足首の臨床研究

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Complications and Mortality after Major Amputation in Patients with Critical Limb Ischemia: A Single Center Experience

Persiani F, Filippi F, D’Andrea A, Raffaele D, Ficarelli R, Panzera C, Rizzo L, Hussein EA and Taurino M

Objectives: Patients with critical limb ischemia (CLI) and undergoing major lower limb amputation carry a high risk of perioperative morbidity and mortality. This paper described complications and mortality rates in the short and long term after major amputation in patients with CLI and analyzed the preoperative comorbidities for predicting postoperative outcomes.

Methods: From January 2004 to March 2017, 140 consecutive major lower extremity amputations were performed in patients affected by CLI. Preoperative comorbidities associated with perioperative complications and mortality after lower extremity amputation were identified and analysed.

Results: Complication rate was 20%. There was a confirmed association between perioperative complications and congestive heart failure (OR 2.8, p=0.02), chronic obstructive pulmonary disease (COPD) (OR 0.3, p=0.02) and hypertension (OR 10.5, p=0.02). In-hospital mortality rate was 26.4% (n=37), 28.4% (n=31) of above-knee amputation (AKA) patients and 19.3% (n=6) of below-knee amputation (BKA) (p=0.3). Congestive heart failure was also significantly associated with in-hospital mortality (OR 2.3, p=0.04). Survival at 1, 2 and 5 years was 61.6%, 58.1% and 39.3% respectively. Advanced age was significant predictor of mortality (OR 3.8, p=0.001). Survival at 1, 2 and 5 years in AKA group was 53.3%, 50.2% and 33.3% respectively compared with BKA group in which survival at 1, 2 and 5 years was 88%, 83.1% and 58.2% respectively (p=0.004).

Conclusions: Nowadays, major amputation remains associated with high complication and mortality rates; some comorbidities seem to be associated with these outcomes.