Factors Associated With Unplanned Reoperation After Above-Knee Amputation

Edwards, Jeffrey B.; Wooster, Mathew; Tran, Thanh; Armstrong, Paul A.; Moudgill, Neil; Shames, Murray L.; Brooks, James D.

doi:10.1001/jamasurg.2018.5074

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…Vasculopathic patients undergoing lower extremity amputation have considerable perioperative morbidity and mortality, with increased risk of revision surgery. 3,15-18 The subgroups of our cohort with PVD demonstrated this risk with higher AKA conversion probabilities (PVD without diabetes, 24.1%; PVD and diabetes, 15.1%) compared with markedly lower conversion probabilities in patients without PVD (≤6%). The lower risk seen in patients with both PVD and diabetes may reflect more thorough surveillance and a lower threshold to diagnose PVD in a diabetic patient.…”

Section: Discussionmentioning

confidence: 67%

“…Clinical factors associated with conversion to AKA were selected based on previous studies-diabetes, renal disease, peripheral vascular disease (PVD), pulmonary disease, and white blood cell count. 3,[13][14][15][16][17][18] The data set included patient demographics, level of amputations, preoperative and postoperative laboratory values, comorbidities, and calculated Charlson Comorbidity Index score identified by International Classification of Diseases codes. 19 Urgent operation, defined by any operation that was not elective, and wound classification (status of surgical wound determined by surgeon: clean, clean/contaminated, contaminated, or dirty/infected) were also collected (see Table 1, Supplementary Digital Content, http://links.lww.com/ JAAOS/A824).…”

Section: Variables and Outcome Measuresmentioning

confidence: 99%

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Mortality and Conversion to Transfemoral Amputation After Transtibial Amputation in the Veterans Affairs Health System

Wong

Woelber

Madison

et al. 2022

J Am Acad Orthop Surg

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Introduction:Transtibial below-knee amputation (BKA) is associated with considerable morbidity, particularly in the vasculopathic population. The purpose of this study was to determine the cumulative probability of undergoing transfemoral above-knee amputation (AKA) conversion within 5 years of BKA and associated risk factors while accounting for the competing risk of death.Methods:This is a retrospective, national database study with structured query of the Veterans Affairs (VA) database for patients who underwent BKA from 1999 to 2020, identified by Current Procedural Terminology codes. Above-knee amputation conversion was identified using Current Procedural Terminology codes in combination with natural language processing to match procedure laterality. After internally validating our patient identification method, risk factors were collected. Competing risk analysis estimated the cumulative incidence rate of AKA conversion and associated risk factors with death as a competing risk.Results:Our query yielded 19,875 patients (19,640 men, 98.8%) who underwent BKA with a median age of 66 years (interquartile range, 60 to 73). The median follow-up was 951 days (interquartile range, 275 to 2,026). The crude cumulative probabilities of AKA conversion and death at 5 years were 15.4% (95% confidence interval [CI], 14.9% to 16.0%) and 47.7% (95% CI, 46.9% to 48.4%), respectively. In the Fine and Gray subdistribution hazard model, peripheral vascular disease had the highest AKA conversion risk (hazard ratio [HR] 2.66; 95% CI, 2.22 to 3.20; P < 0.001). Other factors independently associated with AKA conversion included urgent operation (HR 1.32; 95% CI, 1.23 to 1.42), cerebrovascular disease (HR 1.19; 95% CI, 1.11 to 1.28), chronic obstructive pulmonary disease (HR 1.15; 95% CI, 1.07 to 1.24), and previous myocardial infarction (HR 1.10; 95% CI, 1.02 to 1.19) (All P < 0.02).Discussion:Within this predominantly male, VA population, BKA carries a high risk of conversion to AKA within 5 years, without reaching a steady risk of AKA conversion within 5 years. Peripheral vascular disease, chronic obstructive pulmonary disease, cerebrovascular disease, previous myocardial infarction, and urgent BKA increase the risk of AKA conversion.Level of Evidence:Level III

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Section: Discussionmentioning

confidence: 67%

Section: Variables and Outcome Measuresmentioning

confidence: 99%

Mortality and Conversion to Transfemoral Amputation After Transtibial Amputation in the Veterans Affairs Health System

Wong

Woelber

Madison

et al. 2022

J Am Acad Orthop Surg

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“…Our aim with this data is to establish which elective procedures are associated with high reoperation rates and identify areas in which improving protocols may improve patient outcomes and limit burdens on the healthcare system. Unplanned reoperation is a risk factor for hospital readmission, worsens clinical outcomes, provides the opportunity for additional complications, and increases medical costs for patients [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the risk of return to the operating room across all elective orthopaedic procedures

Kiritsis,

Harris,

Reiter

et al. 2024

J Orthop Surg Res

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Background Although elective procedures have life-changing potential, all surgeries come with an inherent risk of reoperation. There is a gap in knowledge investigating the risk of reoperation across orthopaedics. We aimed to identify the elective orthopaedic procedures with the highest rate of unplanned reoperation and the reasons for these procedures having such high reoperation rates. Methods Patients in the NSQIP database were identified using CPT and ICD-10 codes. We isolated 612,815 orthopaedics procedures from 2018 to 2020 and identified the 10 CPT codes with the greatest rate of unplanned return to the operating room. For each index procedure, we identified the ICD-10 codes for the reoperation procedure and categorized them into infection, mechanical failure, fracture, wound disruption, hematoma or seroma, nerve pathology, other, and unspecified. Results Below knee amputation (BKA) (CPT 27880) had the highest reoperation rate of 6.92% (37 of 535 patients). Posterior-approach thoracic (5.86%) or cervical (4.14%) arthrodesis and cervical laminectomy (3.85%), revision total hip arthroplasty (5.23%), conversion to total hip arthroplasty (4.33%), and revision shoulder arthroplasty (4.22%) were among the remaining highest reoperation rates. The overall leading causes of reoperation were infection (30.1%), mechanical failure (21.1%), and hematoma or seroma (9.4%) for the 10 procedures with the highest reoperation rates. Conclusions This study successfully identified the elective orthopaedic procedures with the highest 30-day return to OR rates. These include BKA, posterior thoracic and cervical spinal arthrodesis, revision hip arthroplasty, revision total shoulder arthroplasty, and cervical laminectomy. With this data, we can identify areas across orthopaedics in which revising protocols may improve patient outcomes and limit the burden of reoperations on patients and the healthcare system. Future studies should focus on the long-term physical and financial impact that these reoperations may have on patients and hospital systems. Level of clinical evidence IV.

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The Modified Frailty Index Does Not Predict Mortality After Major Lower Extremity Amputation for Peripheral Arterial Disease in an Asian Population

D'cruz

Chong

Tan

et al. 2020

Annals of Vascular Surgery

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Factors Associated With Unplanned Reoperation After Above-Knee Amputation

Abstract: Role of the Funder/Sponsor: The funder/sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Cited by 4 publications

References 6 publications

Mortality and Conversion to Transfemoral Amputation After Transtibial Amputation in the Veterans Affairs Health System

Mortality and Conversion to Transfemoral Amputation After Transtibial Amputation in the Veterans Affairs Health System

Evaluating the risk of return to the operating room across all elective orthopaedic procedures

The Modified Frailty Index Does Not Predict Mortality After Major Lower Extremity Amputation for Peripheral Arterial Disease in an Asian Population

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