Short-term Mortality, Morbidity and Recovery Milestones after Major Lower Limb Amputation: a Prospective Evaluation of Outcomes in a Tertiary Center

Abstract

Major lower limb amputation (MLLA) is well recognized to carry a high rate of mortality; however, little evidence explores the reasons for this. Even fewer studies look at other outcomes after MLLA such as major morbidity and functional and social recovery. This study aims to provide a contemporary analysis of these outcomes to contextualize the current state of care for MLLA in the United Kingdom. All index MLLAs conducted in a single tertiary vascular center over a 1-year period were entered into the study. Data including demographic details, preoperative biochemical markers, and functional and social status were collected by a multidisciplinary team . Postoperative functional recovery milestones, and mortality and major morbidity data were collected prospectively from the date of amputation. Descriptive, univariate and multivariate analysis was used to present the results. Seventy-nine amputations were performed. The median total length of stay was 28.0days (interquartile range [IQR] 14.0-48.0), and postoperative length was 18.0days (IQR 9.5-36.0). Thirty-day mortality was 5.1% (n=4), and 90-day mortality was 8.9% (n=7). Thirty-day major morbidity was 32.4% (n=24). After controlling for age and gender, preoperative serum white cell count was an independent predictor of 30-day mortality (odds ratio [OR] 1.375 [95% confidence interval [CI] 1.080-1.751]), 90-day mortality (OR 1.258 [95% CI 1.078-1.469]), and 30-day major morbidity (OR 1.228 [95% CI 1.070-1.409]. The proportion of the population living independently reduced from 56.7% to 13.7%, with 23.3% requiring further rehabilitation. The number needing either social care at home or permanent care placement rose by 12.8%. MLLA carries clinically significant risk of short-term mortality and morbidity. The only factor found to be consistently influential was preoperative serum white cell count. MLLA requires a significant in-hospital stay, and there is a significant deterioration in functional and social status after discharge from hospital.