Outcomes Of Lower Extremity Amputations Research Articles

Does Specialty Matter? A Comparison of Early Postoperative Clinical Outcomes Following Lower Extremity Amputations Between Orthopaedic Surgeon and Vascular Surgeon

Category: Other Introduction/Purpose: Lower extremity amputations are performed by several specialties, with orthopaedic surgery (OS) and vascular surgery (VS) being the two most prevalent. Outcomes following lower extremity amputations, including complications, discharge destination, the rates of mortality, reoperation, and readmission, may vary between these specialties. This variation could be attributed to the underlying reasons for amputation (traumatic vs. vascular) and the urgency level of each case. Understanding the distinctions in outcomes of lower extremity amputations between these surgical specialties could enable surgeons to predict patient outcomes and set realistic patient expectations more accurately. To our knowledge, there is no research comparing postoperative outcomes of lower extremity amputations across these specialties. Our study aims to fill this gap by analyzing data from the National Surgical Quality Improvement Program (NSQIP). Methods: This study analyzed data from NSQIP spanning the years 2016 to 2018, focusing on patients who underwent primary lower extremity amputations. The NSQIP database was searched using Current Procedural Terminology (CPT) codes to identify these patients. The scope of primary amputations included not only below-knee amputations (BKAs) but also above-knee amputations (AKAs) and amputations involving the hindfoot, midfoot, and forefoot. The CPT codes employed for this comprehensive search were 27590, 27591, 27592, 27598, 27880, 27881, 27882, 27888, 27889, 28800, 28805, 28810, 28820, and 28825. The study compared differences in demographics, comorbidities, surgical procedures, and early 30-day postoperative outcomes between the OS and VS. Primary outcomes included mortality, readmission, reoperation, while secondary outcomes focused on complications such as sepsis, infection, wound disruption, DVT/PE, ventilator use greater than 48 hours, perioperative blood transfusion, pneumonia, unplanned reintubation, acute renal failure, urinary tract infection, cardiac arrest, myocardial infarction, and stroke. Results: 16,475 cases were included in this study. 2,556 (15.6%) were conducted by OS while 10,077 (61.1%) by VS. 3,842 (23.3%) were conducted by other specialties, including general surgery and they are not included in our comparison. OS had more emergent cases than elective (16.6% Vs. 13.8%). Regarding the primary outcomes, surgeries by VS showed higher rates of mortality (6.5% Vs. 3.8%), reoperations (9.6% Vs. 7.5%), and readmissions (15.0% Vs. 12.3%). VS had longer length of stay (10.8 days Vs. 8.2 days) and more often tended to have a non-home disposition (81.2% Vs.51.8%). OS showed longer OR time (78.3 minutes Vs. 62.9 minutes). There was no significant difference in the rate of secondary outcomes between two groups, including infection, wound disruption, and DVT/PE. Conclusion: Equivalent outcomes following lower extremity amputations between OS and VS were observed in secondary outcomes, including infections and DVT/PE. However, OS had more emergency cases and longer OR time. VS had significantly higher rates of mortality, reoperation, and readmission in the early 30-day postoperative period, and a greater tendency for non-home dispositions. This indicates that patients requiring amputations under the care of VS may experience more complicated postoperative courses. Further analysis is necessary to better correlate diagnoses with these outcomes, which could enhance the prediction of patient outcomes, including potential complications, and help in setting more accurate realistic patient expectations.

Risk Factor Profile of Amputation in Diabetic Foot Patients in Dr. Soetomo General Academic Hospital, Surabaya, from 2019 to 2020

Highlights: Certain variables are known to be risk factors associated with the outcome of lower extremity amputation among diabetic foot patients. The patient population was observed to be slightly female-biased, with a high prevalence of older age, abnormally high blood sugar and HbA1c, and a history of nephropathy, dyslipidemia, and hypertension. Prior history of vascular diseases, prior amputation history, and heavy smoking were observed but not as prevalent. Abstract Introduction: This study aimed to find the general distribution of certain variables as risk factors for lower extremity amputation among diabetic foot patients at the Inpatient Ward of the Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, from 2019 to 2020. Methods: This was a descriptive-retrospective study using data from medical records. The Statistical Package for the Social Sciences (SPSS) was used to calculate the distribution through the Kolmogorov-Smirnov test. Results: The mean ± SD of age was 55.38 ± 7.503 years old and was slightly female-biased. The median (min-max) blood sugar level was 212.00 (85–446) mg/dL. Fifteen out of 16 patients had an HbA1c beyond 7.0%. The body mass index (BMI) of most patients was between normal and overweight, with a mean ± SD of 24.018 ± 4.1827. 15% of patients were smokers. Strokes were present in 3.9% of patients, cardiovascular diseases were present in 13.73% of patients, prior lower extremity amputation (LEA) history was present in 15.7% of patients, hypertension was present in 49% of patients, and dyslipidemia was present in 13 of 15 patients. The mean estimated glomerular filtration rate (eGFR) was 70.15 ± 34.498 mL/min/1.732. Conclusion: Older age, high blood sugar, high HbA1c levels, nephropathy, dyslipidemia, and hypertension had a high prevalence. Smoking, cardiovascular diseases, strokes, and prior amputation had a low prevalence. Gram-negative bacterial infection was observed in almost all reported patients. ABI results were either mostly not assessable or abnormally high. Most of the patients’ Wagner gradings were in the worst category.

Quality of life and complications in lower limb amputees in Tanzania: results from a pilot study

Abstract Background The most common reason for lower extremity amputation in developing countries is trauma, which is an increasingly recognised global epidemic. Despite the rising rates of traumatic injury and the level of disability experienced by amputees, there are few data focusing on this specific population in low-income and middle-income countries (LMICs). The purpose of this study is to investigate the causes and health-related outcomes of lower extremity amputations in Tanzania, and the socioeconomic barriers preventing access to prosthetics. Methods This was an observational pilot study conducted at the Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania, from 2015 to 2016. Adult patients who had undergone lower extremity amputation less than 1 year before enrolment were included. Baseline data on demographics, socioeconomic factors, and health-related information were collected at enrolment. Patients' health, health-related quality of life (using the EQ-5D questionnaire), and complication data were recorded 3 and 6 months later. Findings We enrolled 44 patients, 35 of whom were men, with a mean age of 39·5 years. 39 (89%) of the patients were employed (36 [82%] informally) and 36 (82%) had no health insurance. Below-knee amputations were the most common (23 [52%]) type of amputation. The most common cause of amputation was trauma (29 [66%]), followed by diabetes (7 [16%]), vascular pathology (3 [7%]), and tumours (2 [5%]). Complications including delayed healing, infection, and wound dehiscence were seen in 20 (51%) of the 39 patients who were followed up. Seven patients required reoperation. The average baseline EQ-5D index was 0·912. The population norm based on mean age is 0·889 for the USA and 0·793 for Zimbabwe (the only African country-specific norm available). The average EQ5D index at 3 months and 6 months decreased to 0·714 and 0·847, respectively. Only two amputees (5%) have received a prosthetic. Lack of materials, unsuitable wound, and cost were most commonly cited as barriers to prosthetics. Interpretation This study demonstrates that amputees in Tanzania experience a high rate of post-operative complications, poor quality of life, and extremely limited access to prosthetics. Educational initiatives to reduce wound-related complications and improved access to lower extremity prosthetics and rehabilitation are needed to address the dearth of knowledge and resources for amputees. Funding Global Research Initiative.

Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events

ObjectivesThe aim of this study was to describe associations of the presence of lipid-rich necrotic core (LRNC) in the proximal superficial femoral artery (SFA) with lower extremity peripheral artery disease (PAD) event rates and systemic cardiovascular event rates. BackgroundLRNC in the coronary and carotid arteries is associated with adverse outcomes but has not been studied previously in lower extremity arteries. MethodsParticipants with ankle-brachial index (ABI) values <1.00 were identified from Chicago medical centers and followed annually. Magnetic resonance imaging was used to characterize SFA atherosclerotic plaque at baseline. Medical records for hospitalizations and procedures after baseline were adjudicated for lower extremity revascularization, amputation, and critical limb ischemia and also for new coronary events, ischemic stroke, and mortality. ResultsOf 254 participants with PAD, 62 (24%) had LRNC and 149 (59%) had calcium in the SFA at baseline. Cox regression analyses were adjusted for age, sex, race, comorbidities, baseline ABI, and other confounders. SFA LRNC was associated with an increased incidence of the combined outcome of lower extremity amputation, critical limb ischemia, ABI decline >0.15, and revascularization at 47-month follow-up (hazard ratio: 2.18; 95% confidence interval: 1.27 to 3.75; p = 0.005). The association of SFA LRNC with PAD events was maintained even when this combined outcome excluded lower extremity revascularization (hazard ratio: 2.58; 95% confidence interval: 1.25 to 5.33; p = 0.01). LRNC in the SFA was not associated with all-cause mortality, acute coronary events, or stroke. ConclusionsAmong patients with PAD, LRNC in the SFA was associated with higher rates of clinical PAD events, and this association was independent of ABI. Further study is needed to determine whether interventions that reduce SFA LRNC prevent PAD events.

A Canadian population-based description of the indications for lower-extremity amputations and outcomes.

To our knowledge, there have been no previously published reports characterizing lower-extremity amputations in Canada. The objective of this study was to describe the indications and outcomes of lower-extremity amputations in the Canadian population. We performed a retrospective cohort study of all adult patients who underwent lower-extremity amputation in Canada between 2006 and 2009. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database, which includes all hospital admissions across Canada with the exception of the province of Quebec. Pediatric, trauma, and outpatients were excluded. During the study period, 5342 patients underwent lower-extremity amputations in 207 Canadian hospitals. The mean age was 67 ± 13 years, and 68% were men. Amputations were most frequently indicated after admission for diabetic complications (81%), cardiovascular disease (6%), or cancer (3%). In total, 65% of patients were discharged to another inpatient or long-term care facility, and 26% were discharged home with or without extra support. Most patients were diabetic (96%) and most (65%) required a below-knee amputation. Predictors of prolonged (> 7 d) hospital stay included amputation performed by a general surgeon; cardiovascular risk factors, such as diabetes, hypertension, ischemic heart disease, congestive heart failure, or hyperlipidemia; and undergoing the amputation in the provinces of Newfoundland and Labrador, New Brunswick, or British Columbia. There is variability in the delivery of lower-extremity amputations and postoperative hospital discharges among surgical specialists and regions across Canada. Future work is needed to investigate the reasons for this variability and to develop initiatives to shorten postoperative hospital stays.

National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001–2012

AimsTo describe trends in the incidence and outcomes of lower-extremity amputations (LEAs) in patients with T1DM and T2DM in Spain, 2001–2012. MethodsWe used national hospital discharge data. Incidence of discharges attributed to LEA procedures were calculated stratified by diabetes status and type of LEA. Joinpoint log-linear regression for incidence trends and logistic regression for factors associated with in-hospital mortality were used. ResultsFrom 2001 to 2012, 73,302 minor LEAs and 64,710 major LEAs were performed. We found that incidence of minor LEA procedures in T1DM patients decreased by 9.84% per year from 2001 to 2008 and then remained stable through 2012. In T2DM patients, LEA increased by 1.89% per year over the entire study period. Among patients with T1DM, major LEA incidence rate decreased by 10.5% from 2001 to 2012. In patients with T2DM, it increased by 4.29% from 2001 to 2004, and then decreased by 1.85% through 2012. In-hospital mortality after major or minor LEAs was associated with older age in all groups and with being female in T2DM and in people without diabetes. ConclusionsOur national data show a decrease in the incidence of minor LEAs in patients with diabetes and in major LEAS in patients with T1DM over the period of study. In patients with T2DM, we found a decrease between 2004 and 2012. An additional improvement in preventive care, such as the introduction of diabetes foot units in hospitals, is necessary.

Clinical results and outcome of lower extremity amputation

Clinical results and outcome of lower extremity amputation

Outcomes of Lower Extremity Amputations

In an effort to identify variables that could be used to predict outcomes of amputation, a cohort of 97 veteran amputees with a median age of 64 years who underwent 155 lower extremity procedures during 1984 was followed for 15 months. A high incidence of postoperative complication, revision, and mortality with poor quality of life confirm the serious prognosis of these individuals. Regression analyses indicated that peripheral vascular disease and prolonged preoperative hospitalization were associated with complications. Preoperative gangrene and peripheral vascular disease were associated with the need for revision. Complications, a low body mass index, and multiple diseases were related to death. Those with multiple diseases and extensive atherosclerosis were less likely to walk. Ability to perform activities of daily living was the most important predictor of quality of life. Patients at higher risk for these adverse outcomes need to be identified early in their hospital stay. The involvement of the patient or his or her surrogate in decisions regarding the course of treatment and the level of amputation is essential.