Results of lower extremity amputations in patients with end-stage renal disease.
OBJECTIVE
The purpose of this study was to determine the impact of end-stage renal disease (ESRD) on the outcome of patients undergoing lower extremity (LE) amputation.


METHODS
Hospital charts and vascular surgery registry data were reviewed for all patients who underwent LE amputation over a consecutive 56-month period. The results of 84 patients with ESRD (137 amputations) were compared with 375 patients (442 amputations) without ESRD.


RESULTS
Hospital mortality rate was significantly greater in patients with ESRD than patients without ESRD, 24% versus 7% (p = 0.001). Patients with ESRD undergoing minor amputations had mortality rates three times greater than patients without ESRD undergoing major LE amputations. In patients with ESRD requiring bilateral or unilateral above-knee amputation hospital mortality rates were 43% and 38%, respectively. In addition, patients with ESRD were seven times more likely to undergo bilateral amputation than patients without ESRD over a mean follow-up period of 17 months. No kidney transplant patients died after amputation.


CONCLUSIONS
ESRD has a profound negative impact on morbidity, mortality, and survival rates after LE amputation. Attempts at prevention of amputation with aggressive foot care and patient education in this high-risk group should be the focus of therapy.
Department of Surgery, Henry Ford Hospital, Detroit, MI 48202.
C D
CD
Dossa
A D
AD
Shepard
A M
AM
Amos
W L
WL
Kupin
D J
DJ
Reddy
J P
JP
Elliott
J M
JM
Wilczwski
C B
CB
Ernst
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016030:Kidney Transplantation; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D006435:Renal Dialysis; D012189:Retrospective Studies