PMID- 32822759
OWN - NLM
STAT- MEDLINE
DCOM- 20210118
LR  - 20221207
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 70
DP  - 2021 Jan
TI  - The Impact of a Limb Preservation Service on the Incidence of Major Amputations 
      for All Indications at a Level I Trauma Center.
PG  - 43-50
LID - S0890-5096(20)30639-7 [pii]
LID - 10.1016/j.avsg.2020.08.001 [doi]
AB  - BACKGROUND: Multidisciplinary limb preservation services (LPS) have improved the 
      care of patients with limb-threatening vascular disease. However, the impact of 
      an LPS on major amputations for nonvascular etiologies is unknown. We sought to 
      characterize the trends in major amputations performed at a level I trauma center 
      following the institution of an LPS. METHODS: A retrospective review of all 
      patients undergoing amputation at a level I trauma center from January 2009 to 
      December 2018 was performed. Patients were divided into 2 cohorts: those 
      undergoing amputation pre-LPS (2009-2013) and post-LPS (2014-2018). Major 
      amputations were defined as any amputation at or proximal to the below-knee 
      level. Indications for amputation included chronic limb-threatening ischemia 
      (CLTI), acute limb ischemia (ALI), trauma, infection, and revision amputations. 
      RESULTS: During the study period, 609 major amputations were performed, 490 
      pre-LPS and 119 post-LPS, representing a 76% reduction. Reductions were seen for 
      every indication, including trauma (95%), ALI (90%), chronic infection (83%), 
      revision (79%), CLTI (68%), and acute infection (62%). CONCLUSIONS: Although 
      previous work has validated the role of an LPS in advanced vascular disease, its 
      value extends beyond vascular disease alone. The drastic reductions seen in the 
      number of amputations performed for a variety of indications, including trauma 
      and diabetic foot infections, further validate the use of a multidisciplinary 
      LPS.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Hemingway, Jake
AU  - Hemingway J
AD  - Division of Vascular Surgery, Department of Surgery, University of Washington, 
      Seattle, WA. Electronic address: heminj@uw.edu.
FAU - Hoffman, Rachel
AU  - Hoffman R
AD  - Division of Vascular Surgery, Department of Surgery, University of Washington, 
      Seattle, WA.
FAU - Starnes, Benjamin
AU  - Starnes B
AD  - Division of Vascular Surgery, Department of Surgery, University of Washington, 
      Seattle, WA.
FAU - Quiroga, Elina
AU  - Quiroga E
AD  - Division of Vascular Surgery, Department of Surgery, University of Washington, 
      Seattle, WA.
FAU - Tran, Nam
AU  - Tran N
AD  - Division of Vascular Surgery, Department of Surgery, University of Washington, 
      Seattle, WA.
FAU - Singh, Niten
AU  - Singh N
AD  - Division of Vascular Surgery, Department of Surgery, University of Washington, 
      Seattle, WA.
LA  - eng
PT  - Journal Article
DEP - 20200818
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Adult
MH  - Aged
MH  - Amputation, Surgical/*trends
MH  - Female
MH  - Humans
MH  - Limb Salvage/*trends
MH  - Male
MH  - Middle Aged
MH  - Program Evaluation
MH  - Retrospective Studies
MH  - Time Factors
MH  - Trauma Centers/*trends
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/*trends
EDAT- 2020/08/22 06:00
MHDA- 2021/01/20 06:00
CRDT- 2020/08/22 06:00
PHST- 2020/02/29 00:00 [received]
PHST- 2020/08/04 00:00 [revised]
PHST- 2020/08/04 00:00 [accepted]
PHST- 2020/08/22 06:00 [pubmed]
PHST- 2021/01/20 06:00 [medline]
PHST- 2020/08/22 06:00 [entrez]
AID - S0890-5096(20)30639-7 [pii]
AID - 10.1016/j.avsg.2020.08.001 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2021 Jan;70:43-50. doi: 10.1016/j.avsg.2020.08.001. Epub 2020 Aug 
      18.