Margaret Wan Nar Wong1. 1. Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong. mwnwong@cuhk.edu.hk
Abstract
BACKGROUND: The identification of independent predictors for operative and long-term mortality after lower-extremity amputations in the geriatric population would allow targeted management for high-risk patients and appropriate allocation of resources. METHODS: Univariate and multivariate logistic regression analyses were used to identify independent predictors for operative mortality. Life tables and Kaplan-Meier survival curves were generated. Independent predictors for long-term mortality were tested by log-rank test followed by Cox regression analysis. RESULTS: Female gender, congestive heart failure, and high-level amputation were identified as independent predictors for operative mortality (odds ratios 4.14, 4.59, and 4.77, respectively). The logistic regression model showed good calibration and discriminative power. Female gender, high-level amputation, cerebrovascular accident, congestive heart failure, noncommunity ambulation, and institutionalization before amputation were associated with an increased risk for long-term mortality. However, only high-level amputation, congestive heart failure, and noncommunity ambulation remained as independent risk factors after Cox regression analysis (relative risks 1.68, 2.08, and 2.10, respectively). CONCLUSIONS: Extra care should be given to patients identified with independent predictors for operative and long-term mortality.
BACKGROUND: The identification of independent predictors for operative and long-term mortality after lower-extremity amputations in the geriatric population would allow targeted management for high-risk patients and appropriate allocation of resources. METHODS: Univariate and multivariate logistic regression analyses were used to identify independent predictors for operative mortality. Life tables and Kaplan-Meier survival curves were generated. Independent predictors for long-term mortality were tested by log-rank test followed by Cox regression analysis. RESULTS: Female gender, congestive heart failure, and high-level amputation were identified as independent predictors for operative mortality (odds ratios 4.14, 4.59, and 4.77, respectively). The logistic regression model showed good calibration and discriminative power. Female gender, high-level amputation, cerebrovascular accident, congestive heart failure, noncommunity ambulation, and institutionalization before amputation were associated with an increased risk for long-term mortality. However, only high-level amputation, congestive heart failure, and noncommunity ambulation remained as independent risk factors after Cox regression analysis (relative risks 1.68, 2.08, and 2.10, respectively). CONCLUSIONS: Extra care should be given to patients identified with independent predictors for operative and long-term mortality.
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