Prognostic Factors for Amputation Following Surgical Repair of Lower Extremity Vascular Trauma: A Systematic Review and Meta-Analysis of Observational Studies

Date

2014-06-01

Author

Perkins, Zane B.
Yet, Barbaros
Glasgow, Simon
Marsh, William
Brohi, Karim
Rasmussen, Todd E.
Tai, Nigel R.

Metadata

Show full item record

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Item Usage Stats

230
views

0
downloads

Background: Lower extremity vascular trauma (LEVT) is a major cause of amputation. A clear understanding of prognostic factors for amputation is important to inform surgical decision-making, patient counselling and risk stratification. The aim was to develop an understanding of prognostic factors for amputation following surgical repair of LEVT. Methods: A systematic review was conducted to identify potential prognostic factors. Bayesian meta-analysis was used to calculate an absolute (pooled proportion) and relative (pooled odds ratio, OR) measure of the amputation risk for each factor. Results: Forty-five studies, totalling 3187 discrete LEVT repairs, were included. The overall amputation rate was 10·0 (95 per cent credible interval 7·4 to 13·1) per cent. Significant prognostic factors for secondary amputation included: associated major soft tissue injury (26 versus 8 per cent for no soft tissue injury; OR 5·80), compartment syndrome (28 versus 6 per cent; OR 5·11), multiple arterial injuries (18 versus 9 per cent; OR 4·85), duration of ischaemia exceeding 6 h (24 versus 5 per cent; OR 4·40), associated fracture (14 versus 2 per cent; OR 4·30), mechanism of injury (blast 19 per cent, blunt 16 per cent, penetrating 5 per cent), anatomical site of injury (iliac 18 per cent, popliteal 14 per cent, tibial 10 per cent, femoral 4 per cent), age over 55 years (16 versus 9 per cent; OR 3·03) and sex (men 7 per cent versus women 8 per cent; OR 0·64). Shock and nerve or venous injuries were not significant prognostic factors for secondary amputation. Conclusion: A significant proportion of patients who undergo lower extremity vascular trauma repair will require secondary amputation. This meta-analysis describes significant prognostic factors needed to inform surgical judgement, risk assessment and patient counselling.

Subject Keywords

Surgery, Peripheral vascular disease

URI

https://hdl.handle.net/11511/57573

DOI

https://doi.org/10.1016/j.jvs.2014.03.167

Collections

Graduate School of Informatics, Conference / Seminar

Suggestions

OpenMETU
Core

Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma Perkins, Z. B.; Yet, Barbaros; Glasgow, S.; Cole, E.; Marsh, W.; Brohi, K.; Rasmussen, T. E.; Tai, N. R. M. (Wiley, 2015-04-01) Background: Lower extremity vascular trauma (LEVT) is a major cause of amputation. A clear understanding of prognostic factors for amputation is important to inform surgical decision-making, patient counselling and risk stratification. The aim was to develop an understanding of prognostic factors for amputation following surgical repair of LEVT.
Predicting the Outcome of Limb Revascularization in Patients With Lower-extremity Arterial Trauma: Development and External Validation of a Supervised Machine-learning Algorithm to Support Surgical Decisions. Perkins, Zane B.; Yet, Barbaros; Sharrock, Anna; Rickard, Rory; Marsh, William; Rasmussen, Todd E.; Tai, Nigel R M (Ovid Technologies (Wolters Kluwer Health), 2020-10-01) Objectives: Estimating the likely success of limb revascularization in patients with lower-extremity arterial trauma is central to decisions between attempting limb salvage and amputation. However, the projected outcome is often unclear at the time these decisions need to be made, making them difficult and threatening sound judgement. The objective of this study was to develop and validate a prediction model that can quantify an individual patient's risk of failed revascularization. Methods: A BN progno...
THE RISK-FACTORS IN CENTRAL VENOUS CATHETER-RELATED THROMBOSIS KOKSOY, C; KUZU, A; ERDEN, I; Akkaya, Ayşen (Wiley, 1995-11-01) Catheter-related venous thrombosis is one of the most important complications of central venous catheters. The aim of this prospective study was to assess the risk factors that may be important in the development of catheter-related thrombosis. Multiple lumen (n = 20) and single lumen (n = 24) polyurethane catheters were inserted to the subclavian vein by the infraclavicular approach in 44 consecutive patients. All variables that may be significant for the development of thrombosis related to the patient, t...
Biomechanics of porous ceramic implants used in long-bones segmental defect healing Balçık, Cenk; Tokdemir, Turgut; Korkusuz, Feza; Department of Engineering Sciences (2002) Reconstruction of bone in segmental defect is a challenging orthopedic application in which nonunion is seen due to loss of tissue and atrophic bonding inability. Calcium and phosphate based ceramics are the new generation of bone grafts to be used in large segmental defects as they show excellent biocompatibility, biodegradability and osteoconductivity. Ideal ceramic composition, configuration and material property compatible to cortical bone is yet to be determined. It is hypothesized that long-bones segm...
Etiology of senile osteoporosis - A hypothesis Atik, O. Sahap; Uslu, M. Murad; Eksioglu, Fatih; Satana, Tolgay (Ovid Technologies (Wolters Kluwer Health), 2006-02-01) Osteoporosis is a major health problem characterized by compromised bone strength predisposing patients to an increased risk of fracture. It may cause morbidity and mortality in elderly men and women. The etiologic factors that lead to senile osteoporosis still are unclear.

Citation Formats

Z. B. Perkins et al., “Prognostic Factors for Amputation Following Surgical Repair of Lower Extremity Vascular Trauma: A Systematic Review and Meta-Analysis of Observational Studies,” 2014, vol. 59, Accessed: 00, 2020. [Online]. Available: https://hdl.handle.net/11511/57573.