Back to Search
Start Over
Impact of time to repair on outcomes in patients with lower extremity arterial injuries
- Source :
- Journal of vascular surgery. 69(5)
- Publication Year :
- 2018
-
Abstract
- Background Six hours has long been considered the threshold of ischemia after peripheral artery injury. However, there is a paucity of evidence regarding the impact of operative delays on morbidity and mortality in patients with lower extremity arterial injuries. Methods We analyzed the records of 3,441,259 injured patients entered into the National Trauma Data Bank Research Dataset from 2012 to 2015. Patients (≥16 years) with lower extremity arterial injuries were identified by International Classification of Diseases, Ninth Revision injury and procedure codes. Patients with crush injuries, patients with prehospital or emergency department cardiac arrest, those not transferred directly from point of injury, and patients in whom a nonoperative management strategy was attempted were excluded from analysis. Results We examined the data from 4406 patients with lower extremity arterial injuries; 85% of the patients were male, with a mean age of 35 years. The overall mortality in this cohort was 3.2% (143/4406); the amputation rate was 11.3% (499/4406). Using a multivariate logistic regression model, blunt mechanisms of injury, increased time from injury to operating room arrival, nerve injury, associated lower extremity fractures, increased age, and Injury Severity Score were associated with increased amputation risk. The amputation rate in those undergoing repair within 60 minutes was 6% compared with 11.7% and 13.4% in those undergoing repair after 1 to 3 hours and 3 to 6 hours, respectively. Conclusions Optimal limb salvage is achieved when revascularization of lower extremity arterial injury occurs within 1 hour of injury. To improve survival and recovery after extremity arterial injury, efforts should be focused on strategies to expedite reperfusion of the injured limb.
- Subjects :
- Adult
Male
Time Factors
Databases, Factual
medicine.medical_treatment
Ischemia
030204 cardiovascular system & hematology
Revascularization
Risk Assessment
Amputation, Surgical
Fasciotomy
Time-to-Treatment
03 medical and health sciences
0302 clinical medicine
Risk Factors
medicine
Humans
030212 general & internal medicine
Retrospective Studies
business.industry
Emergency department
Arteries
Nerve injury
Vascular System Injuries
medicine.disease
Limb Salvage
United States
Treatment Outcome
Amputation
Lower Extremity
Anesthesia
Crush injury
Injury Severity Score
Surgery
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Vascular Surgical Procedures
Subjects
Details
- ISSN :
- 10976809
- Volume :
- 69
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of vascular surgery
- Accession number :
- edsair.doi.dedup.....745c50b0ec6d60cc544419ed452b4ce2