• Tak Kyu Oh and In-Ae Song.
• Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, Korea.
• J Anesth. 2021 Feb 1; 35 (1): 515851-58.

PurposePeripheral gangrene (PG) is a known complication requiring limb amputation among sepsis survivors; however, its incidence and associated risk factors remain controversial. We aimed to examine the incidence of limb amputation among sepsis survivors, and to investigate factors independently associated with limb amputation.MethodsIn this population-based cohort study, data obtained from the South Korean national health insurance service database between 2015 and 2016 were analyzed. A sepsis survivor was defined as someone having survived > 90 days after initiation of treatment for sepsis.ResultsOf 19,906 sepsis survivors, 163 (0.8%) had undergone surgical limb amputation. In a multivariable model, male sex (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.26-2.40; P = 0.001), dopamine infusion (OR 1.78, 95% CI 1.22-2.60; P = 0.003), epinephrine infusion (OR 2.04, 95% CI 1.30-3.20; P = 0.002), continuous renal replacement therapy (OR 3.34, 95% CI 2.01-3.20; P < 0.001), diabetes mellitus (DM) without chronic complication (OR 1.73, 95% CI 1.19-2.51; P = 0.004), DM with chronic complication (OR 3.49, 95% CI 2.32-5.26; P < 0.001), and peripheral arterial disease (OR 6.79, 95% CO 3.70-12.46; P < 0.001) were associated with a higher incidence of limb amputation among sepsis survivors.ConclusionsIn South Korea, 0.8% of sepsis survivors underwent limb amputation for the treatment of PG. Furthermore, the incidence of limb amputation was higher among the sepsis survivors having some underlying diseases (DM and peripheral arterial diseases) or receiving certain vasopressor treatments (epinephrine and dopamine).

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