title: Major lower extremity amputation: outcome of a modern series.
abstract: 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.
authors.affiliation: Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. 02215, USA. baulivo@caregroup.harvard.edu
authors.forename: Bernadette
authors.initials: B
authors.lastname: Aulivola
authors.forename: Chantel N
authors.initials: CN
authors.lastname: Hile
authors.forename: Allen D
authors.initials: AD
authors.lastname: Hamdan
authors.forename: Malachi G
authors.initials: MG
authors.lastname: Sheahan
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Veraldi
authors.forename: John J
authors.initials: JJ
authors.lastname: Skillman
authors.forename: David R
authors.initials: DR
authors.lastname: Campbell
authors.forename: Sherry D
authors.initials: SD
authors.lastname: Scovell
authors.forename: Frank W
authors.initials: FW
authors.lastname: LoGerfo
authors.forename: Frank B
authors.initials: FB
authors.lastname: Pomposelli
mesh_terms: 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