Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore
Journal Title: Research and Practice in Anesthesiology – Open Journal - Year 2017, Vol 2, Issue 2
Abstract
Background: Non-traumatic Major Lower Extremity Amputation (MLEA) surgeries are associated with high post-operative morbidity and mortality rates. There are few studies evaluating factors associated with post-operative mortality rates for MLEA among Asian patients. Objective: To identify factors that affect post-operative mortality rate and ICU admission rates in patients undergoing non-traumatic MLEA surgeries in a tertiary institution in Singapore. Method: A retrospective study was performed by using the operating theatre electronic database to identify patients who underwent non-traumatic MLEA surgeries in Singapore General Hospital during the period of January 1, 2010 to December 31, 2011. Results: Data was collected from 186 non-traumatic MLEA surgeries performed during the study period. Overall post-operative in hospital mortality rate was 8.6%, higher for above knee amputation (AKA), than Through Knee Amputation (TKA) than Below Knee Amputation (BKA) (18.4% vs. 8% vs. 4.5%, p=0.015). In multivariate logistic regression analysis, site of amputation of AKA compared to BKA (odds ratio 3.9, 95% confidence interval 1.1-14.5, p=0.04), ASA 4 status (odds ratio 4.3, 95% confidence interval 1.2-14.6, p=0.02) and presence of septic shock (odds ratio 4.9, 95% confidence interval 1.4-17.3, p=0.01) were significant predictors of post-operative in hospital mortality rate. The same 3 factors were significant predictors of post-operative ICU admission rate. Use of peripheral nerve block as the sole anaesthetic technique did not affect in-hospital mortality rate (adjusted odds ratio 1.3, 95% confidence interval 0.3-5.6). Conclusion: Patients with ASA 4 status and pre-operative septic shock, especially those undergoing AKA, should be considered as high risk group and therefore managed appropriately. The higher incidence of post-operative ICU admission rate in this group of patients also necessitates pre-operative organization of bed availability. Using peripheral nerve block as the sole anaesthetic technique did not significantly affect outcomes measured.
Authors and Affiliations
Ong Ee Teng
Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore
Background: Non-traumatic Major Lower Extremity Amputation (MLEA) surgeries are associated with high post-operative morbidity and mortality rates. There are few studies evaluating factors associated with post-operative m...
Positioning and Anesthesia Challenges In a Morbidly Obese Patient Undergoing Cervical Spine Surgery
Background Context: By itself, the perioperative anesthesia management of morbidly obese patients is challenging; this task is further complicated when such patients have to be placed in the prone position for surgery. I...
Anticipated Difficult Intubation Due to Polypoidal Squamous Cell Carcinoma on Posterior One Third of Tongue
The most common type of tongue malignancy is squamous cell carcinoma (SCC) which constitutes about 36.5% of all oral malignancies.1 It usually presents as painless swelling which is oftenignored by the patient until late...
Laryngeal Transection in a Patient after Hanging
Introduction: Hanging has become the second most common method of attempted suicide among adolescents and hanging injuries are associated with a high overall mortality rate.1 Laryngeal injuries were observed in 35% to 45...
Effect of the Irrigation Fluid Temperature on Core Temperature in Transurethral Resection of Prostate Patients Under Spinal Versus General Anaesthesia
Study Design:Prospective, randomized control trial. Objectives:To evaluate and compare the effect of warm and unwarmed irrigation fluid and anaesthetic technique on core temperature in patients undergoing Transurethral r...