Abstract
BackgroundSurgical treatment of peripheral vascular disease (PVD) in dialysis patients is controversial.MethodsWe examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation.ResultsOf the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896) or amputation (n = 2,046) in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR) 19.0, 95% CI (confidence interval) 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71) in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (< 33rd percentile of propensity score) and moderate likelihood of amputation (33rd to 66th percentile) but not in high likelihood group (>66th percentile). The number of hospital days in the amputation and revascularization groups was not different.ConclusionAmputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.
Highlights
Surgical treatment of peripheral vascular disease (PVD) in dialysis patients is controversial
BMC Nephrology 2005, 6:3 http://www.biomedcentral.com/1471-2369/6/3 management of PVD in the dialysis population remains controversial. It has been suggested by some authors that because of delayed wound healing and prolonged hospitalization, primary amputation is preferred over revascularization for PVD in dialysis patients while others have argued that a careful selection of dialysis patients for revascularization might result in acceptable outcomes [512]
Study population Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, those who underwent surgical revascularization or amputation within 6 months of initiation of dialysis were studied
Summary
Surgical treatment of peripheral vascular disease (PVD) in dialysis patients is controversial. Peripheral vascular disease is common and carries considerable morbidity and mortality in dialysis patients. BMC Nephrology 2005, 6:3 http://www.biomedcentral.com/1471-2369/6/3 management of PVD in the dialysis population remains controversial. It has been suggested by some authors that because of delayed wound healing and prolonged hospitalization, primary amputation is preferred over revascularization for PVD in dialysis patients while others have argued that a careful selection of dialysis patients for revascularization might result in acceptable outcomes [512]. We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a large cohort of Medicare dialysis patients
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