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Major Lower Extremity Amputation
Outcome of a Modern Series
Bernadette Aulivola, MD;
Chantel N. Hile, MD;
Allen D. Hamdan, MD;
Malachi G. Sheahan, MD;
Jennifer R. Veraldi, BA;
John J. Skillman, MD;
David R. Campbell, MD;
Sherry D. Scovell, MD;
Frank W. LoGerfo, MD;
Frank B. Pomposelli, Jr, MD
Arch Surg. 2004;139:395-399.
Hypothesis Major lower extremity amputation results in significant morbidity and mortality.
Design Retrospective database query and medical record review for January 1, 1990, to December 31, 2001. Mean follow-up was 33.6 months.
Setting Academic tertiary care center.
Patients Nine hundred fifty-nine consecutive major lower extremity amputations in 788 patients, including 704 below-knee amputations (BKAs) (73.4%) and 255 above-knee amputations (AKAs) (26.6%).
Main Outcome Measures Patient survival, cardiac morbidity, infectious complications, and subsequent operation.
Results Overall 30-day mortality was 8.6%, worse for AKA (16.5%) than BKA (5.7%) patients (P<.001). Thirty-day mortality for guillotine amputation for sepsis control was 14.3% compared with 7.8% for closed amputation (P = .03). Complications included cardiac (10.2%), wound infection (5.5%), and pneumonia (4.5%). Twelve AKA (4.7%) and 129 BKA (18.4%) limbs required subsequent operation. Only 66 BKAs (9.4%) required conversion to AKA (average, 77.1 days postoperatively). Overall survival was 69.7% and 34.7% at 1 and 5 years, respectively. Survival was significantly worse for AKAs (50.6% and 22.5%) than BKAs (74.5% and 37.8%) (P<.001). Survival in patients with diabetes mellitus (DM) was 69.4% and 30.9% vs 70.8% and 51.0% in patients without DM at 1 and 5 years, respectively (P = .002). Survival in end-stage renal disease patients was 51.9% and 14.4% vs 75.4% and 42.2% in patients without renal failure at 1 and 5 years, respectively (P<.001).
Conclusions Major amputation continues to result in significant morbidity and mortality. Survivors with BKA require revision or conversion to AKA infrequently. Long-term survival is dismal for patients with DM and end-stage renal disease and those undergoing AKA.
From the Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
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