title: The impact of previous surgery and revisions on outcome after major lower limb amputation.
abstract: BACKGROUND
  Morbidity and mortality after lower limb amputation (LLA) remain disappointingly high. This study aimed to assess the impact of previous ipsilateral vascular intervention on outcomes after major LLA.
  
  
  METHODS
  Prospective data were collected for all major LLAs performed between January 2010 and December 2011. Those who underwent a primary amputation were compared with secondary amputees to establish if previous interventions were a risk factor for morbidity and mortality.
  
  
  RESULTS
  One hundred forty-eight patients underwent LLA during the study period; 102 were primary amputees, and 46 (31.1%) had undergone previous ipsilateral revascularization. The groups were well matched for demographics and comorbidities. Those who underwent secondary amputations were older (P=0.016) and more likely to suffer from hypercholesterolemia (P<0.001). Patients who had undergone a previous intervention were more likely to need revision surgery (17% vs. 4.5% P=0.027). Previous intervention was not found to be a risk factor for more proximal amputation level (P=0.341) or increased postoperative mortality (P=0.782), however.
  
  
  CONCLUSIONS
  Patients who have undergone previous revascularization may be at higher risk of revision surgery. Survival after major LLA does not appear to be associated with previous revascularization attempts.
authors.affiliation: Academic Vascular Surgical Unit, Hull and East Yorkshire NHS Trust/Hull York Medical School, Hull, UK. Electronic address: Rachel.Barnes@hey.nhs.uk.
authors.forename: Rachel
authors.initials: R
authors.lastname: Barnes
authors.affiliation: Academic Vascular Surgical Unit, Hull and East Yorkshire NHS Trust/Hull York Medical School, Hull, UK.
authors.forename: Panos
authors.initials: P
authors.lastname: Souroullas
authors.affiliation: Academic Vascular Surgical Unit, Hull and East Yorkshire NHS Trust/Hull York Medical School, Hull, UK.
authors.forename: Risha A
authors.initials: RA
authors.lastname: Lane
authors.affiliation: Academic Vascular Surgical Unit, Hull and East Yorkshire NHS Trust/Hull York Medical School, Hull, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Chetter
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods*