J J van Netten1, L V Fortington2, R J Hinchliffe3, J M Hijmans4. 1. Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands. Electronic address: jaapvannetten@gmail.com. 2. Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia. 3. St. George's Vascular Institute, St. George's Healthcare NHS Trust, London, UK. 4. University of Groningen, University Medical Center, Department of Rehabilitation Medicine, Groningen, The Netherlands.
Abstract
OBJECTIVE: Lower limb amputation is often associated with a high risk of early post-operative mortality. Mortality rates are also increasingly being put forward as a possible benchmark for surgical performance. The primary aim of this systematic review is to investigate early post-operative mortality following a major lower limb amputation in population/regional based studies, and reported factors that might influence these mortality outcomes. METHODS: Embase, PubMed, Cinahl and Psycinfo were searched for publications in any language on 30 day or in hospital mortality after major lower limb amputation in population/regional based studies. PRISMA guidelines were followed. A self developed checklist was used to assess quality and susceptibility to bias. Summary data were extracted for the percentage of the population who died; pooling of quantitative results was not possible because of methodological differences between studies. RESULTS: Of the 9,082 publications identified, results were included from 21. The percentage of the population undergoing amputation who died within 30 days ranged from 7% to 22%, the in hospital equivalent was 4-20%. Transfemoral amputation and older age were found to have a higher proportion of early post-operative mortality, compared with transtibial and younger age, respectively. Other patient factors or surgical treatment choices related to increased early post-operative mortality varied between studies. CONCLUSIONS: Early post-operative mortality rates vary from 4% to 22%. There are very limited data presented for patient related factors (age, comorbidities) that influence mortality. Even less is known about factors related to surgical treatment choices, being limited to amputation level. More information is needed to allow comparison across studies or for any benchmarking of acceptable mortality rates. Agreement is needed on key factors to be reported.
OBJECTIVE: Lower limb amputation is often associated with a high risk of early post-operative mortality. Mortality rates are also increasingly being put forward as a possible benchmark for surgical performance. The primary aim of this systematic review is to investigate early post-operative mortality following a major lower limb amputation in population/regional based studies, and reported factors that might influence these mortality outcomes. METHODS: Embase, PubMed, Cinahl and Psycinfo were searched for publications in any language on 30 day or in hospital mortality after major lower limb amputation in population/regional based studies. PRISMA guidelines were followed. A self developed checklist was used to assess quality and susceptibility to bias. Summary data were extracted for the percentage of the population who died; pooling of quantitative results was not possible because of methodological differences between studies. RESULTS: Of the 9,082 publications identified, results were included from 21. The percentage of the population undergoing amputation who died within 30 days ranged from 7% to 22%, the in hospital equivalent was 4-20%. Transfemoral amputation and older age were found to have a higher proportion of early post-operative mortality, compared with transtibial and younger age, respectively. Other patient factors or surgical treatment choices related to increased early post-operative mortality varied between studies. CONCLUSIONS: Early post-operative mortality rates vary from 4% to 22%. There are very limited data presented for patient related factors (age, comorbidities) that influence mortality. Even less is known about factors related to surgical treatment choices, being limited to amputation level. More information is needed to allow comparison across studies or for any benchmarking of acceptable mortality rates. Agreement is needed on key factors to be reported.
Authors: Aaron J Deutsch; C Charles Jain; Kimberly G Blumenthal; Mark W Dickinson; Anne M Neilan Journal: Ann Vasc Surg Date: 2017-07-21 Impact factor: 1.466
Authors: D C Norvell; M L Thompson; E J Boyko; G Landry; A J Littman; W G Henderson; A P Turner; C Maynard; K P Moore; J M Czerniecki Journal: Br J Surg Date: 2019-03-13 Impact factor: 6.939
Authors: Peter A Lazzarini; Sheree E Hurn; Suzanne S Kuys; Maarten C Kamp; Vanessa Ng; Courtney Thomas; Scott Jen; Jude Wills; Ewan M Kinnear; Michael C d'Emden; Lloyd F Reed Journal: J Diabetes Res Date: 2017-10-15 Impact factor: 4.011