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Arch Surg. 2004 Apr;139(4):395-9; discussion 399.

Major lower extremity amputation: outcome of a modern series.

Author information

1
Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. 02215, USA. baulivo@caregroup.harvard.edu

Abstract

HYPOTHESIS:

Major lower extremity amputation results in significant morbidity and mortality.

DESIGN:

Retrospective database query and medical record review for January 1, 1990, to December 31, 2001. Mean follow-up was 33.6 months.

SETTING:

Academic tertiary care center.

PATIENTS:

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%).

MAIN OUTCOME MEASURES:

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.

PMID:
15078707
DOI:
10.1001/archsurg.139.4.395
[Indexed for MEDLINE]

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