Surgical apgar score predicts early complication in transfemoral amputees:Retrospective study of 170 major amputations

作     者：Christian Wied Nicolai B Foss Morten T Kristensen Gitte Holm Thomas Kallemose Anders Troelsen 

作者机构：Department of Orthopedic SurgeryCopenhagen University Hospital Hvidovre Department of Anesthesiology and Intensive CareCopenhagen University Hospital Hvidovre Physical Medicine and Rehabilitation Research-CopenhagenDepartment of Physical TherapyCopenhagen University Hospital Hvidovre Clinical Research CentreCopenhagen University Hospital Hvidovre 

出 版 物：《World Journal of Orthopedics》 (世界骨科杂志（英文版）)

年 卷 期：2016年第7卷第12期

页      面：832-838页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Surgical apgar score Mortality Transfemoral amputation Post-operative complication Lower extremity amputation 

摘      要：AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations *** This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of *** A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-