Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

BMC Nephrol. 2005 Mar 21;6:3. doi: 10.1186/1471-2369-6-3.

Abstract

Background: Surgical treatment of peripheral vascular disease (PVD) in dialysis patients is controversial.

Methods: We 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.

Results: Of 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 within 1 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.

Conclusion: Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Amputation* / adverse effects
  • Amputation* / mortality
  • Cohort Studies
  • Humans
  • Logistic Models
  • Middle Aged
  • Peripheral Vascular Diseases / surgery*
  • Retrospective Studies
  • Vascular Surgical Procedures* / adverse effects
  • Vascular Surgical Procedures* / mortality