Mortality prediction following non‐traumatic amputation of the lower extremity.
Published: 13th March 2019
Authors: D. C. Norvell, M. L. Thompson, E. J. Boyko, G. Landry, A. J. Littman, W. G. Henderson et al.
Patients who undergo lower extremity amputation secondary to the complications of diabetes or peripheral artery disease have poor long‐term survival. Providing patients and surgeons with individual‐patient, rather than population, survival estimates provides them with important information to make individualized treatment decisions.
Patients with peripheral artery disease and/or diabetes undergoing their first unilateral transmetatarsal, transtibial or transfemoral amputation were identified in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. Stepdown logistic regression was used to develop a 1‐year mortality risk prediction model from a list of 33 candidate predictors using data from three of five Department of Veterans Affairs national geographical regions. External geographical validation was performed using data from the remaining two regions. Calibration and discrimination were assessed in the development and validation samples.
The development sample included 5028 patients and the validation sample 2140. The final mortality prediction model (AMPREDICT‐Mortality) included amputation level, age, BMI, race, functional status, congestive heart failure, dialysis, blood urea nitrogen level, and white blood cell and platelet counts. The model fit in the validation sample was good. The area under the receiver operating characteristic (ROC) curve for the validation sample was 0·76 and Cox calibration regression indicated excellent calibration (slope 0·96, 95 per cent c.i. 0·85 to 1·06; intercept 0·02, 95 per cent c.i. –0·12 to 0·17). Given the external validation characteristics, the development and validation samples were combined, giving a total sample of 7168.
The AMPREDICT‐Mortality prediction model is a validated parsimonious model that can be used to inform the 1‐year mortality risk following non‐traumatic lower extremity amputation of patients with peripheral artery disease or diabetes.Full text
You may also be interested in
Meta‐analysis of the outcomes of treatment of internal carotid artery near occlusion. BJS 2019; 106: 665-671.
Authors: A. J. A. Meershoek, E. E. Vries, D. Veen, H. M. Ruijter, G. J. Borst, A. Garcia‐Pastor et al.
Authors: S. F. Cheng, M. M. Brown, R. J. Simister, T. Richards
Baseline findings of the population‐based, randomized, multifaceted Danish cardiovascular screening trial (DANCAVAS) of men aged 65–74 years.
Authors: J. S. Lindholt, L. M. Rasmussen, R. Søgaard, J. Lambrechtsen, F. H. Steffensen, L. Frost et al.
Randomized clinical trial
Randomized clinical trial of mechanochemical and endovenous thermal ablation of great saphenous varicose veins. BJS 2019; 106: 548-554.
Authors: S. Vähäaho, O. Mahmoud, K. Halmesmäki, A. Albäck, K. Noronen, P. Vikatmaa et al.
Meta‐analysis of long‐term survival after elective endovascular or open repair of abdominal aortic aneurysm. BJS 2019; 106: 523-533.
Authors: R. M. A. Bulder, E. Bastiaannet, J. F. Hamming, J. H. N. Lindeman
Meta‐analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease. BJS 2019; 106: 319-331.
Authors: J. Golledge, T. P. Singh, C. Alahakoon, J. Pinchbeck, L. Yip, J. V. Moxon et al.
Cost‐effectiveness analysis of a randomized clinical trial of early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration. BJS 2019; 106: 555-562.
Authors: D. M. Epstein, M. S. Gohel, F. Heatley, X. Liu, A. Bradbury, R. Bulbulia et al.
Meta‐analysis of negative pressure wound therapy of closed groin incisions in arterial surgery. BJS 2019; 106: 310-318.
Authors: R. Svensson‐Björk, M. Zarrouk, G. Asciutto, J. Hasselmann, S. Acosta
Influence of psoas muscle area on mortality following elective abdominal aortic aneurysm repair. BJS 2019; 106: 367-374.
Authors: M. A. Waduud, B. Wood, P. Keleabetswe, J. Manning, E. Linton, M. Drozd et al.
Cost‐effectiveness of targeted screening for abdominal aortic aneurysm in siblings. BJS 2019; 106: 206-216.
Authors: R. Hultgren, A. Linné, S. Svensjö
Notes: Cost effective
Systematic review of endovascular intervention and surgery for common femoral artery atherosclerotic disease. BJS 2019; 106: 13-22.
Authors: X. Jia, Z. D. Sun, J. V. Patel, K. Flood, D. D. Stocken, D. J. A. Scott et al.
Sex differences in national rates of repair of emergency abdominal aortic aneurysm. BJS 2019; 106: 82-89.
Authors: A. Aber, T. S. Tong, J. Chilcott, P. Thokala, R. Maheswaran, S. M. Thomas et al.
Notes: Why worse for women?