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· DOS Abstracts
Mortality analysis and Failure to Rescue in dysvas-
cular lower extremity amputees: implications for
future treatment protocols.
Christian Wied, Nicolai Bang Foss, Peter Toft Tengberg, Gitte Holm, Anders Tro-
elsen, Morten Tange Kristensen
Orthopaedic Surgery, Hvidovre Hospital; Anesthesiology and Intensive Care,
Hvidovre Hospital; Orthopaedic Surgery, Hvidovre Hospital; Orthopaedic Sur-
gery, Hvidovre Hospital; Orthopaedic Surgery, Hvidovre Hospital; Physical Med-
icine and Rehabilitation Research-Copenhagen (PMR-C), Hvidovre Hospital
Background:
Extremely high 30-days mortality rates in excess of 30% have
been reported following major dysvascular lower extremity amputations (LEA).
The treatment of these patients is most often challenged by several competing
co- morbidities. However, an enhanced treatment program seems to decrease
30- days mortality rates below 20%, but the potential and limitations for fur-
ther reduction in mortality and morbidity are unknown.
Purpose / Aim of Study:
To analyzes postoperative causes of 30-days mor-
tality in an enhanced treatment program, and to introduce Failure to Rescue
(FTR) in LEA surgery.
Materials and Methods:
The medical charts of 195 consecutive LEA proce-
dures were reviewed independently by three of the authors, and deaths during
hospitalization following amputation were classified according to consensus.
Findings / Results:
31 (16%) patients died within 30-days after surgery.
Patients with diabetes or transfemoral amputation (TFA) were in significantly
higher risk of 30-days mortality in a log binominal regression model [p=0.007
& p=0.029)]. Patients who died had a higher incidence of sepsis [20% vs. 4%,
p=0.008] and pneumonia [32% vs. 4%, p<0.001] compared to those alive. 4
deaths were classified as “definitely unavoidable”, 4 as “probably unavoidable”,
and 23 as “FTR”. When compared to the survivors with complications, the FTR
rate was 27%. Of the FTR deaths, 20 patients had at some time-point active
lifesaving care curtailed. The 22 patients who died in the TFA sub- group re-
ceived significantly more blood transfusions (p=0.020) compared to the 88 pa-
tients alive in the TFA group.
Conclusions:
It seems warranted that future initiatives should be directed at
enhanced sepsis and pneumonia prophylactic actions, in addition to close moni-
toring of hemodynamics in anemic patients, with the potential to further reduce
morbidity and mortality rates.
No conflicts of interest reported
136.