20 Chronic Cardiovascular Dysfunction Following Lower Extremity Amputation in Burn Patients

Abstract

\n \n \n Long-term chronic cardiovascular dysfunction is a well-reported outcome in patients who have suffered severe burns associated with diminished muscle mass and hypermetabolism. Devastating burn injuries sometimes warrant extremity amputation to preserve life over limb. A lower extremity amputation can exacerbate the risk of burn-related sequelae due to prolonged recovery and reduced mobility. We queried a large multi-institutional national database to investigate whether lower extremity amputations in those with severe burns were associated with increased incidence of chronic myocardial dysfunction syndromes.\n \n \n \n We accessed the TriNetX Global Health Research Network and queried ICD-10 codes for burn injuries (T20-25, T30-32) across 41 participating health care organizations. Comparative cohorts of patients who underwent lower extremity amputations and those who did not were identified. A matched case-control analysis of these cohorts accounting for age and gender matching was compared for the subsequent diagnosis of chronic cardiac dysfunction syndromes (I50.22, I50.32, I50.42, I50.812).\n \n \n \n A total of 347,156 patients did not undergo lower extremity amputation, and their demographics showed a mean age of 38 years, 54% males, 60% white and 18% African American. In contrast, 1,535 patients underwent lower extremity amputation with a mean age was 59 years, 73% were male, 60% white and 24% African American. Burn patients who underwent amputations showed a comparative increased risk of 5.77% (p < 0.0001) for developing of chronic cardiac dysfunction compared to those who did not undergo amputations (RR 3.512, 95% CI: 2.39–5.16). One year following injury this comparative risk diminished to 3.45% (p < 0.0001; RR 3.14, 95% CI: 1.96–5.04). The difference in risk was not significant 3 years after burn injury (0.538%, p = 0.2163, RR 1.54, 95% CI: 0.77–3.09).\n \n \n \n Patients who underwent amputations after severe burn are at increased risk of developing chronic cardiac dysfunction compared to those that did not undergo amputation; the significance appears to diminish with time. Further research is indicated to elucidate the mechanism for this relationship.\n