Effect of anaesthetic technique on mortality following major lower extremity amputation: a propensity score-matched observational study.

We investigated whether the type of anaesthesia affects mortality and length of stay after non-traumatic major lower extremity amputations. A total of 1365 eligible patients who were operated on between 2002 and 2010 were included in the final analysis. Propensity score matching was used to produce 475 matched pairs of patients undergoing operation with either general or regional anaesthesia. We found that 30-day mortality was significantly greater in the general anaesthesia group compared with the regional anaesthesia group, with an odds ratio (95% CI) of 1.5 (1.0-2.3) in the total matched population and 4.2 (1.3-13.4) in a high-risk subgroup. The median (IQR [range]) length of postoperative hospital stay was significantly less in the patients of the high-risk subgroup who had general anaesthesia at 15 (7-21 [1-101]) days compared with 25 days (10-37 [0-78]) for those who had regional anaesthesia (p = 0.027). The results of our study suggest that 30-day mortality is significantly higher in patients undergoing major lower extremity amputations under general anaesthesia compared with regional anaesthesia.

Prevalence of and risk factors for peripheral arterial disease in older adults in an Australian emergency department.

The aim of the paper is to estimate the prevalence of symptomatic and asymptomatic peripheral arterial disease (PAD) in emergency department (ED) patients aged 50 years or more and to identify associated clinical and demographic factors. A prospective cross-sectional study was conducted at a single ED. The main outcome was estimated prevalence of PAD (ankle brachial index <0.9 in either leg). Demographic and clinical history data were collected. The San Diego Claudication Questionnaire (SDCQ), the Intermittent Claudication Questionnaire (ICQ) and the Kessler Psychological Distress Scale (K10) were also administered. Participants with a positive diagnosis of PAD were referred for further management and followed up by telephone. A total of 329 ED patients aged >50 years were screened. PAD prevalence was 10.3% (95% Cl 7.5-14.1%). The prevalence of symptomatic and asymptomatic PAD was 6.4% (95% CI 4.2-9.6%) and 3.9% (95% Cl 2.3-6.7%), respectively. PAD prevalence increased significantly with age rising to 25.7% (95% Cl 17.0-36.7) among those 180 years. Multivariate analyses revealed that being aged 180 years (odds ratio [OR] 5.97,95% CI 2.74-13.02), having a history of angina (OR 3.034, 95% CI 1.35-6.80) and being a former smoker (2.77, 95% CI 1.23-6.22) were the strongest predictors of PAD. In conclusion, targeted screening for PAD among the older ED population identifies ED patients with PAD.