终末期肾病和慢性肢体危重缺血患者的预后:基于人群的队列研究

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-10-15 DOI:10.1097/SLA.0000000000006566
Samir K Shah, Dan Neal, Terrie Vasilopoulos, Mark Segal, Scott Berceli, Joel S Weissman
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引用次数: 0

摘要

目的了解终末期肾病(ESKD)和慢性肢体缺血(CLTI)患者在未接受程序性治疗、初次截肢、血管内治疗和开放手术后的死亡率和次要预后:背景数据摘要:ESKD 和 CLTI 通常同时存在,而之前有限的研究表明,尽管进行了治疗,但疗效不佳,包括一年的存活率:我们对美国肾脏数据系统 2016 年 1 月 1 日至 2019 年 12 月 31 日的数据进行了一项回顾性全国队列研究,以确定死亡率、主要术后并发症和其他结果。我们采用倾向匹配法进行了一项探索性分析,比较了不同治疗方法的两年生存率:在1,876,652份诊断为CLTI的记录中,我们发现了3,908名患有ESKD并被诊断为CLTI的患者。确诊 CLTI 时的平均年龄为 65.7 岁,其中 2,405 人(61.5%)为男性。2,696名患者(69.0%)未接受手术治疗,609名患者(15.6%)接受了大肢截肢手术,439名患者(11.2%)接受了血管内治疗,164名患者(4.2%)接受了开放手术。一年的死亡率为 44.9%,主要术后并发症为 41.8%,90 天再入院率为 52.6%。在比较两年存活率时,我们发现截肢组和血管内手术组之间没有差异(P=0.08),血管内手术组和开放手术组之间也没有差异(P=0.06)。与截肢组相比,开放手术组的两年生存率更高(P=0.002):结论:同时患有ESKD和CLTI的患者无论接受何种治疗,都会出现不良预后。探索性分析表明,三种主要手术治疗方法的两年生存率相似,但接受开放式治疗的患者的生存率高于接受原发性截肢的患者。
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Outcomes among Patients with End-Stage Kidney Disease and Chronic Limb-Threatening Ischemia: A Population-based Cohort Study.

Objective: To understand mortality and secondary outcomes in patients with both end-stage kidney disease (ESKD) and chronic limb-threatening ischemia (CLTI) after no procedural treatment, primary amputation, endovascular treatment, and open surgery.

Summary background data: ESKD and CLTI commonly cooccur and limited prior work has demonstrated poor outcomes including one-year survival despite treatment.

Methods: We conducted a retrospective national cohort study of United States Renal Data System data from January 1, 2016 to December 31, 2019 to determine mortality, major postoperative complications, and other outcomes. We performed an exploratory analysis comparing two-year survival by treatment using propensity matching.

Results: Of 1,876,652 records with a CLTI diagnosis, we identified 3,908 patients with ESKD and an incident CLTI diagnosis. Mean age at CLTI diagnosis was 65.7 years and 2,405 (61.5%) were male. 2,696 (69.0%) had no procedural treatment, 609 (15.6%) had major limb amputation, 439 (11.2%) had endovascular treatment, and 164 (4.2%) had open surgery. There was 44.9% mortality at one year, along with 41.8% major postoperative complications and 52.6% readmissions at 90 days. Comparing two-year survival, we found no differences between the amputation and endovascular cohorts (P=0.08) and between endovascular and open (P=.06). There was superior two-year survival in the open surgery cohort compared to the amputation cohort (P=0.002).

Conclusions: Patients living with both ESKD and CLTI experience poor outcomes irrespective of treatment. Exploratory analyses demonstrated that two-year survival among the three principal procedural treatments was similar except for superior survival among patients undergoing open therapy compared to primary amputation.

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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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