title: Chronic kidney disease predicts long-term mortality after major lower extremity amputation.
abstract: BACKGROUND
  Despite low peri-operative mortality after major lower extremity amputation, long-term mortality remains substantial. Metabolic syndrome is increasing in incidence and prevalence at an alarming rate in the USA.
  
  
  OBJECTIVE
  This study was to determine whether metabolic syndrome predicts outcome after major lower extremity amputation.
  
  
  METHODS
  A retrospective review of charts between July 2005 and June 2010.
  
  
  RESULTS
  Fifty-four patients underwent a total of 60 major lower extremity amputations. Sixty percent underwent below-knee amputation and 40% underwent above-knee amputation. The 30-day mortality was 7% with no difference in level (below-knee amputation, 8%; above-knee amputation, 4%; P = 0.53). The mean follow-up time was 39.7 months. The 5-year survival was 54% in the whole group, and was independent of level of amputation (P = 0.24) or urgency of the procedure (P = 0.51). Survival was significantly decreased by the presence of underlying chronic kidney disease (P = 0.04) but not by other comorbidities (history of myocardial infarction, P = 0.79; metabolic syndrome, P = 0.64; diabetes mellitus, P = 0.56).
  
  
  CONCLUSIONS
  Metabolic syndrome is not associated with increased risk of adverse outcomes after lower extremity amputation. However, patients with chronic kidney disease constitute a sub-group of patients at higher risk of postoperative long-term mortality and may be a group to target for intervention.
authors: Department of Surgery, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA ; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors: Roland
authors: R
authors: Assi
authors: Department of Medicine, Mount Sinai Hospital, Icahn School of Medicine, New York, USA.
authors: Yorg
authors: Y
authors: Al Azzi
authors: Department of Surgery, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA ; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors: Clinton D
authors: CD
authors: Protack
authors: Department of Surgery, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA ; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors: Willis T
authors: WT
authors: Williams
authors: Department of Surgery, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA ; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors: Michael R
authors: MR
authors: Hall
authors: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors: Daniel J
authors: DJ
authors: Wong
authors: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors: Daniel Y
authors: DY
authors: Lu
authors: Department of Surgery, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.
authors: Penny
authors: P
authors: Vasilas
authors: Department of Surgery, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA ; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors: Alan
authors: A
authors: Dardik
keywords: Chronic kidney disease; Lower extremity amputation; Metabolic syndrome; Mortality; Peripheral artery disease