title: Factors affecting functional outcome after lower extremity amputation.
abstract: BACKGROUND
  More than 100,000 major lower extremity amputations -- amputations at the metatarsal, below-knee or above-knee level -- are performed yearly in the United States. Despite improvements in long-term outcome, operative mortality following such amputations has remained stable at 9% to 10% over the last 20 years. Several predictors for functional outcome of amputee patients are mentioned in the literature.
  
  
  OBJECTIVE
  The current study was planned to assess the impact of comorbidities on functional status after lower extremity amputations.
  
  
  METHODS
  It was a prospective comparative study held at the Department of Orthopaedics and Traumatology, Punjab Medical College, Faisalabad, and affiliated hospitals. The study included 104 patients regardless of age and gender. Patients were allocated into trans-metatarsal (TM) group, below-knee (BK) amputation group and above-knee (AK) amputation group. Comorbidities before amputation included diabetes mellitus (70.7%), coronary heart disease (57.1%), chronic kidney disease (53.6%), and/or congestive heart failure (52.1%).
  
  
  RESULTS
  Mortality within 30 days of hospital discharge was 9%, and hospital readmission was 27.7%. Stroke, end-stage renal disease (ESRD) and poor baseline cognitive function were associated with the poorest functional outcome after amputation. Patients undergoing BK or AK amputation failed to return to their functional baseline within 6 months.
  
  
  CONCLUSIONS
  Higher amputation level, history of stroke, ESRD, poor baseline cognitive scores, and female gender are factors associated with inferior functional status after amputation.
authors.affiliation: Department of General Surgery, Allied Hospital, Punjab Medical College, Faisalabad.
authors.forename: Abdullah Bin
authors.initials: AB
authors.lastname: Saeed
authors.affiliation: Department of Orthopedic Surgery, Allied Hospital, Punjab Medical College, Faisalabad.
authors.forename: Usama Bin
authors.initials: UB
authors.lastname: Saeed
authors.affiliation: Department of Orthopedic Surgery, Allied Hospital, Punjab Medical College, Faisalabad.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Zain-Ur-Rehman
authors.affiliation: Department of Orthopedic Surgery, Allied Hospital, Punjab Medical College, Faisalabad.
authors.forename: Rana Dawood
authors.initials: RD
authors.lastname: Ahmad Khan
authors.affiliation: Department of Orthopedic Surgery, Allied Hospital, Punjab Medical College, Faisalabad.
authors.forename: Ajmal
authors.initials: A
authors.lastname: Yasin
keywords: Lower extremity amputation, Co-morbidities, Minimum data set, Recovery of function.