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

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World Journal of Orthopedics 2016年第12期7卷 832-838页

作者： Christian Wied Nicolai B Foss Morten T Kristensen gitte holm Thomas Kallemose Anders Troelsen Department of Orthopedic Surgery Copenhagen University Hospital Hvidovre Department of Anesthesiology and Intensive Care Copenhagen University Hospital Hvidovre Physical Medicine and Rehabilitation Research-Copenhagen Department of Physical TherapyCopenhagen University Hospital Hvidovre Clinical Research Centre Copenhagen University Hospital Hvidovre

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-

关键词： Surgical apgar score Mortality Transfemoral amputation Post-operative complication Lower extremity amputation

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Tourniquets do not increase the total blood loss or reamputation risk in transtibial amputations

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World Journal of Orthopedics 2017年第1期8卷 62-67页

作者： Christian Wied Peter T Tengberg gitte holm Thomas Kallemose Nicolai B Foss Anders Troelsen Morten T Kristensen Depart-ment of Orthopedic Surgery Copenhagen University Hospital Hvidovre Clinical Research Centre Copenhagen University Hospital Hvidovre Department of Anesthesiology and Intensive Care Copenhagen University Hospital Hvidovre Physical Medicine and Rehabilita-tion Research--Copenhagen Department of Physical TherapyCopenhagen University Hospital Hvidovre

AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed with sagittalflaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmH g above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss(OBL), which is defined as the volume of blood lost during surgery, was determined from the suction volume and by the weight difference of the surgical dressings. The trigger for a blood transfusion was set at a decrease in the Hgb level < 9.67 g/dL(6 mmol/L). Transfusions were performed with pooled red blood cells containing 245 m L per portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. RESULTS Seventy-four out of 86 consecutive patients who underwent TTA within the two-year study period were included in the analysis. Of these, 38 were operated on using a tourniquet and 36 were operated on without using a tourniquet. There were no significant preoperative differences between the groups. The patients in both groups had a postoperative decrease in their Hgb level compared with preoperative baseline values. The patients operated on using a tourniquet received approximately three millilitres less blood transfusion per kilogram body weight compared with patients o

关键词： Total blood loss Intraoperative blood loss Transtibial amputation Lower extremity amputation Pneumatic tourniquet Re-amputation

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