1141 Mortality and Re-Amputation Rates Following Below Knee Amputation: A Systematic Review and Meta-Analysis

Abstract

Abstract Aim Below knee amputation (BKA) is undertaken in patients with diabetes or peripheral vascular disease, when limb sparing medical optimisation or vascular interventions are no longer feasible. Mortality and proximal re-amputation rates are poorly defined in the literature. We sought to perform a systematic review to examine mortality and reputation rates across the current literature. Method A systematic search was performed of the MEDLINE (via Pubmed), EMBASE, Cochrane and clinicaltrials.gov databases from inception to August 25th, 2022. Articles were screened by two independent reviewers with conflicts reserved by a third party. Inclusion criteria were all non-traumatic causes of lower limb amputation. Outcomes of interest included Mortality and occurrence of more proximal amputation. Results Studies from 12 countries encompassing a total of 41832 patients were included for analysis. Study dates ranged from 1987 to 2019. Of the total patient number, 38577 (92.2%) were from the USA, with 2599 (6.2%) from Europe and 656 (1.6%) remainder. The mean age at BKA was 70.46 years (Range 62-86). Weighted mortality was 37% (Range 4%-29%) at 1 year, 58% (Range 12% - 60%) at 2 years, 65% (range 19% - 81%) at 5 years and 84% (Range 71-96%) at 10 years. Five studies reported re-amputation rate at any time point (13% Range 1.16- 22%). Conclusions Mortality following BKA is still poor, even in contemporary studies. The few large multicentre studies are US based and in military veteran populations. More robust UK focused studies are needed to accurately inform clinical decision making for patients and clinicians.