Major lower extremity amputation: outcome of a modern series.
OBJECTIVE
Major lower extremity amputation results in significant morbidity and mortality.


METHODS
Retrospective database query and medical record review for January 1, 1990, to December 31, 2001. Mean follow-up was 33.6 months.


METHODS
Academic tertiary care center.


METHODS
Nine hundred fifty-nine consecutive major lower extremity amputations in 788 patients, including 704 below-knee amputations (BKAs) (73.4%) and 255 above-knee amputations (AKAs) (26.6%).


METHODS
Patient survival, cardiac morbidity, infectious complications, and subsequent operation.


RESULTS
Overall 30-day mortality was 8.6%, worse for AKA (16.5%) than BKA (5.7%) patients (P<.001). Thirty-day mortality for guillotine amputation for sepsis control was 14.3% compared with 7.8% for closed amputation (P =.03). Complications included cardiac (10.2%), wound infection (5.5%), and pneumonia (4.5%). Twelve AKA (4.7%) and 129 BKA (18.4%) limbs required subsequent operation. Only 66 BKAs (9.4%) required conversion to AKA (average, 77.1 days postoperatively). Overall survival was 69.7% and 34.7% at 1 and 5 years, respectively. Survival was significantly worse for AKAs (50.6% and 22.5%) than BKAs (74.5% and 37.8%) (P<.001). Survival in patients with diabetes mellitus (DM) was 69.4% and 30.9% vs 70.8% and 51.0% in patients without DM at 1 and 5 years, respectively (P =.002). Survival in end-stage renal disease patients was 51.9% and 14.4% vs 75.4% and 42.2% in patients without renal failure at 1 and 5 years, respectively (P<.001).


CONCLUSIONS
Major amputation continues to result in significant morbidity and mortality. Survivors with BKA require revision or conversion to AKA infrequently. Long-term survival is dismal for patients with DM and end-stage renal disease and those undergoing AKA.
Aulivola
Bernadette
B
Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. 02215, USA. baulivo@caregroup.harvard.edu
Hile
Chantel N
CN
Hamdan
Allen D
AD
Sheahan
Malachi G
MG
Veraldi
Jennifer R
JR
Skillman
John J
JJ
Campbell
David R
DR
Scovell
Sherry D
SD
LoGerfo
Frank W
FW
Pomposelli
Frank B
FB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000453:epidemiology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome