A Binary Logistic Regression Analysis Of Risk Factors For Failure Of Lower Extremity Salvage In Trauma Patients: An Examination Of The American College Of Surgeons Trauma Quality Improvement Project
Karen E. Burtt, MD1, Vincent Athas, MD1, Stacey Tannenbaum, PhD1, James Fletcher, MD1, Alex Fokin, MD2, John Berne, MD1.
1Broward Health, Fort Lauderdale, FL, USA, 2Delray Medical Center, Delray Beach, FL, USA.
PURPOSE: In patients with lower extremity soft tissue loss due to trauma, flaps may be placed to cover the defect. Patients may undergo secondary amputation of the limb due to flap necrosis and failure. This study aims to identify the risk factors for failure of limb salvage.METHODS: A retrospective cohort study of the American College of Surgeons Trauma Quality Program (TQP) 2019 Participant Use File (PUF) was performed. Inclusion criteria consisted of adults with a blunt or penetrating injury with operative debridement of the lower leg and tissue transfer during the trauma admission. Exclusion criteria included traumatic amputation, death in ED, transfer to/from another hospital, and missing data. Binary logistic regression analysis evaluated the relationship between patient/injury characteristics and secondary amputation.
RESULTS: Of 1,097,190 patients in the TQP-2019-PUF, 732 patients met inclusion/exclusion criteria, of which 66 underwent lower extremity amputation. Independent significant predictors of failed limb salvage included history of diabetes (Odds ratio[OR] 2.8, 95%CI 1.1-7.3;P=0.04), crush injury (OR 4.4, 95%CI 2.1-9.2;P<0.0001), lower extremity arterial injury (OR 3.3, 95%CI 1.7-6.4;P<0.001), and sepsis (OR 5.7, 95%CI 1.1-30.0;P=0.04). Receiver Operating Characteristic (ROC) analysis found that the model achieved an area under the curve (AUC) of 0.80 (95%CI 0.74-0.86).
CONCLUSION: Patients with diabetes or sepsis who receive lower extremity reconstruction after crush injury or lower extremity arterial injury are at high risk for failure of limb salvage.
Back to 2022 Posters