A predictive score for 30-day survival for patients undergoing major lower limb amputation for peripheral arterial obstructive disease

Abstract

To analyze outcomes following major lower extremity amputations (mLEAs) for peripheral arterial obstructive disease, gangrene, infected non-healing wound and to create a risk prediction scoring system for 30-day mortality. In this single-center, retrospective, observational cohort study. All patients treated with above-the-knee amputation (AKA) or below-the-knee amputation (BKA) between January 1st, 2010 and June 30th, 2018 were identified. The primary outcome of interest was early (≤ 30 days) mortality. Secondary outcomes were postoperative complications and freedom from amputation stump revision/failure. We identified 310 (77.7%) mLEAs performed on 286 patients. There were 188 (65.7%) men and 98 (34.3%) women with a median age of 79 years (IQR, 69–83 years). We performed 257 (82.9%) AKA and 53 (17.1%) BKA. There were 49 (15.8%) early deaths, which did not differ among the age quartiles of this cohort (15.4% vs. 14.3% vs. 15.4% vs. 19.5%, P = 0.826). Binary logistic regression analysis identified age > 80 years (OR 2.24, 95% CI 1.17–4.31; P = 0.015), chronic obstructive pulmonary disease (OR 2.12, 95% CI 1.11–4.06; P = 0.023), and hemodialysis (OR 2.52, 95% CI 1.15–5.52; P = 0.021) to be associated with early mortality. The final score (range 0–10) identified two subgroups with different mortality at 30 days: lower-risk (score < 4, 10.8%), and higher-risk (score ≥ 4: 28.7%; OR 3.2, 95% CI 1.63–6.32; P < 0.001). In our experience, mLEAs still have a 14% mortality rate over the years. Our lower-risk group (score < 4) is characterized by a lower rate of perioperative death and longer survival. Graphic abstract

Short-term risk prediction after major lower limb amputation: PERCEIVE study

“…The largest improvement in discrimination was in a tool predicting mortality following AKA (from 0.789 to 0.827). 29 There remained significant lack of fit when testing calibration (apart from 5 tools), 1,[24][25][26][27] the tendency to under/overestimate risk was unchanged, and Brier scores were comparable to the primary analyses (Supplementary material 2).…”

“…Following title and abstract screening (n=421) and full-text screening (n=5) in the updated systematic search, two further tools described in two papers were identified for evaluation (both predicting mortality at 30-days). 24,25 Following the conclusion of the initial phase of the study, a further two outcome prediction tools were found to be of interest in the context of the PERCEIVE study despite not being specific to MLLA: version 1 and version 2 of the Surgical Outcome Risk Tool (SORT). 26,27 SORT version 1 is a 'traditional' regression-based outcome prediction tool; SORT version 2 incorporates clinician subjective estimation in the regression equation and was, therefore, considered relevant to this study.…”

Long-Term Results of Femorodistal Sequential Composite-Bypass Combining Heparin-Bonded PTFE-Prosthesis and Autologous Vein Using the Deutsch Bridge Technique in Critical Limb-Threatening Ischemia

“…However, even in a modern series for primary major amputation in CLTI patients, 30 day mortality was reported to be between 10.8% for the lower-risk score and 28.7% for the higher-risk score patients. [33] With respect to the poor prognosis for primary amputation, a surgical revascularization approach may be discussed in this high-surgical-risk group with no good endovascular option to preserve patient mobility with a functional limb besides a strict conservative management. The SCBB developed by Deutsch is associated with good late bypass patency and an excel-lent limb salvage rate if performed with a heparin-bonded PTFE-prosthesis.…”