Citation

Bunn C, Kulshrestha S, DiChiaro B, Maduekwe U, Abdelsattar ZM, Baker MS, Luchette FA, Agnew S. J. Am. Coll. Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2021.04.012

PMID

unavailable

Abstract

BACKGROUND: Mangled extremities are one of the most difficult injuries for trauma surgeons to manage. We compare limb salvage rates for a limb-threatening lower extremity injury managed at Level I versus Level II trauma centers (TCs). STUDY DESIGN: We identified all adult patients with a limb-threatening injury who underwent primary amputation or limb salvage (LS) using the American College of Surgeons (ACS) Trauma Quality Improvement Program database at ACS Level I vs. II TCs between 2007 and 2017. A limb-threatening injury was defined as an open tibial fracture with concurrent arterial injury (Gustilo Type IIIc). Multivariable analysis and propensity score matching were performed to minimize confounding by indication.

RESULTS: There were 712 records for analysis; 391 (54.9%) LS performed and 321 (45.1%) underwent amputation. The rate of LS was statistically higher among patients treated at Level I TCs versus those treated at Level II TCs (47.4% vs 34.8%, p=0.01). Patients with penetrating injuries (13% vs 9.5%, p=0.046) and tibial/peroneal artery injury (72.9% vs 50.4%, p<0.001) as opposed to popliteal artery injury (30.8% vs 58.8%, p<0.001) were more likely to have LS. The risk adjusted odds of LS was 3.13 times higher at Level I TCs versus Level II TCs (95% CI [1.59 -6.34], p=0.001). Limb salvage rates were significantly higher at Level I TCs compared to Level II TCs (53.0% vs 34.8%; p=0.004), even after propensity matching.

CONCLUSION: In patients with a mangled extremity, limb salvage rates are 50% higher at Level I TCs compared to Level II TCs, independent of case-mix and injury severity.

Language: en

Keywords

trauma; amputation; limb salvage; reconstruction