Long-term outcomes of major and minor lower limb amputation: eight-year retrospective analysis from a single tertiary referral centre

Abstract

Objective: Lower limb amputation is increasingly common yet outcomes are historically poor, with high rates of short-term mortality, revisions and poor quality of life. This observational study evaluates outcomes from a high-volume tertiary vascular referral centre. Methods: Retrospective electronic case note review was performed to elicit all major and minor amputations performed between 03/11/2014 and 31/05/2022 for peripheral arterial disease and diabetic foot sepsis. Cases of amputation for trauma or chronic pain were not included. Results: A total of 1,566 amputations (865 major, 701 minor) were carried out in 1,237 patients during the study period. Mortality was significantly higher for patients undergoing major amputation compared with minor amputation at 30 days (7.9%, n=61/773 vs 1.0%, n=6/575; p<0.0001) and at 1 year post-procedure (23.7%, n=183/773 vs 13.6%, n=78/575, p<0.0001). Revision rates were significantly lower for major amputations than for minor amputations at 30 days (2.4%, n=19/799 vs 13.2%, n=91/691; p<0.0001) and at 1 year post-procedure (10.0%, n=68/677 vs 26.3%, n=163/619, p<0.0001). Of the patients with major amputation fitted with a prosthesis, there was no significant difference in the numbers of patients ambulating (p=0.19) or the mean ambulatory level (p=0.08) between above-knee and below-knee amputation at 6 months post-procedure. Conclusions: Both major and minor lower limb amputations are associated with a high risk of revision and mortality within 1 year which should be discussed explicitly as part of the informed consent process.