Lower extremity amputation: a contemporary series.
We sought to identify the results achieved with lower extremity amputations performed by both community and university-based surgeons as well as from multiple disciplines (orthopedic/general/vascular surgeons) serving a predominantly nonurban population. A review of 411 consecutive patients undergoing 508 non-traumatic lower extremity amputations at Charleston Area Medical Center from January 1999 to December 2003 was conducted. Amputations were performed most frequently at the below knee level (50.9%). Perioperative mortality (30-day) for the cohort was 11%. Mortality increased with more proximal level of initial amputations: 1.6% for transmetatarsal, 3.6% for below knee, 17.6% for above knee and 100% of those requiring hip disarticulation. Stump failure requiring conversion to a more proximal level was seen in 34.5% of TMA's, 12% of BKA, 6% of AKA during the follow-up period. Twenty-one percent of patients required bilateral amputations by the end of the follow-up period. Non-wound related morbidity for all procedures (i.e. pneumonia, stroke, renal failure) was 29%. Rehabilitation documentation was available for 55% of the cohort, of whom only 27% (N=61) were fitted for, and ambulating with a prosthesis during the follow-up period. Survival at 6 months, 1 year and 2 years was 59%, 47% and 23% respectively. Patients requiring major lower extremity amputation represent the peak of high-risk patients undergoing vascular surgery. Significant perioperative morbidity and limited survival is seen in this cohort. Early vascular surgery referral may reduce more proximal amputations and improve functional outcome in a group with poor longevity and limited functional capacity with amputation at the transtibial level and proximal.
Stone
Patrick A
PA
Vascular Surgery Division, West Virginia University, Charleston Division, USA.
Flaherty
Sarah K
SK
Hayes
J David
JD
AbuRahma
Ali F
AF
D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014903:West Virginia