Clinical factors and mortality rates for non-traumatic upper extremity amputations

Abstract

Non-traumatic upper extremity amputations are an increasing concern with the rising prevalence of diabetes mellitus. To ascertain the risk factors and mortality rates for these amputations, the demographic information, amputation history, comorbidities and clinical outcomes of 140 patients who underwent non-traumatic upper extremity amputations between 1 January 2004 and 31 October 2017 were studied. Correlations were assessed using Cochran-Armitage chi-squared tests, odds ratios and multivariate binomial logistic regression as appropriate. Diabetes mellitus, coronary artery disease, end-stage renal failure, peripheral arterial disease and prior lower extremity amputation were significant risk factors for multiple upper extremity amputations. One-year, 2-year and 5-year mortality rates were 12%, 15% and 38%, respectively, following first upper extremity amputation. The risk factors for upper extremity amputations correspond with those for lower extremity amputations, comprising mainly diabetes mellitus and its related comorbidities. The mortality rates for non-traumatic upper extremity amputations highlight their significant burden on patients. Level of evidence: III

Factors Affecting 30-Day Outcomes in Patients Undergoing Nontraumatic Upper Extremity Amputation: A Retrospective Descriptive Longitudinal Study

“…However, literature on UEAs is limited, with just one single-center retrospective study on nontraumatic UEAs. 18 Our study aimed to identify the incidence rate and risk factors of 30-day MM and mortality in a large cohort of nontraumatic UEA patients.…”

“…Consistent with our findings, Ting et al demonstrated a notable divergence in the survival curves for major and minor nontraumatic UEAs. 18 Nontraumatic shoulder amputations are relatively rare and primarily indicated for cases requiring malignant tumor resection when distal amputation is not feasible. These procedures entail complex surgery involving extensive dissection near critical structures including the brachial plexus and subclavian vessels, increasing the risk of damage.…”

“…First, the ACS-NSQIP database does not include information on patients' earlier LEAs or multiple UEAs, which are potential risk factors for the occurrence of adverse outcomes after nontraumatic UEAs. 18 The database also provides no information on long-term outcomes, hence falling short in assessing the long-term safety of nontraumatic UEAs. In addition, because our data were obtained retrospectively, we encountered missing data for several variables examined in this study.…”

“…10 In addition, the only single-center retrospective study analyzing patients undergoing nontraumatic UEAs between 2004 and 2017 reported DM, coronary artery disease, end-stage renal failure, peripheral arterial disease, and previous LEA to be markedly associated with multiple UEAs and a poor survival of 69% at 5 years . 11 However, the results reported by the study were not generalizable because it was a single-center study and had a small sample size, with 69% of the population belonging only to the Chinese ethnicity.…”