Factors influencing short‐ and long‐term mortality after lower limb amputation

Scott, Sion; Bowrey, Sarah; Clarke, David; Choke, Edward; Bown, Matthew J.; Thompson, Jonathan P.

doi:10.1111/anae.12532

Cited by 46 publications

(47 citation statements)

References 18 publications

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“…2,[5][6][7][8]11,13,[23][24][25] We also observed a high mortality rate of 10.8% in the present study. LLA is often performed as a life-saving measure for a critically ischemic or infected limb in patients with DM or PVD.…”

Section: Discussionsupporting

confidence: 78%

“…These findings are consistent with those in previous studies. 2,[7][8][9]11,23) Little is known about reamputation following LLA, and the present study is the largest study of its kind. Reamputation occurred in 10.1% of patients who underwent foot or transtibial amputation during hospitalization.…”

Section: Discussionmentioning

confidence: 84%

“…[1][2][3][4] Previous studies have also reported high postoperative mortality rates ranging from 4.2% to 13.5% among patients undergoing LLA. 2,3,[5][6][7][8][9][10][11][12] Reported risk factors for death after LLA include age; male sex; the site of amputation; the requirement of dialysis; and a diagnosis of PVD, DM, coronary artery disease, myocardial infarction, or renal insufficiency. 2,3,[5][6][7][8][9][10][11]13) However, most previous studies of LLA were limited because of the selected study populations and small sample sizes.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for In-hospital Mortality and Reamputation Following Lower Limb Amputation

Endoh

Yamana

Nakahara

et al. 2017

PRM

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Objective: Studies on the outcomes of lower limb amputation have been limited by the use of selected study populations and small sample sizes. Although reamputation is an important outcome following lower limb amputation, the risk factors for reamputation remain to be elucidated. The present study was performed to identify risk factors for in-hospital death and reamputation following lower limb amputation. Methods: Using a national inpatient database in Japan, we identified 13,774 patients who underwent lower limb amputation. We examined the patients' backgrounds and employed a multivariable logistic regression analysis to identify factors associated with in-hospital death or reamputation. Results: The average age of the 13,774 patients was 72.4 years, and 63.1% (n=8694) were male. The overall in-hospital mortality rate was 10.8% (1481/13,774). The reamputation rate was 10.1% (782/7779) for patients who initially underwent foot or transtibial amputation (18.2% [391/2148] for foot amputations and 6.9% [391/5631] for transtibial amputations). Multivariable logistic regression analysis revealed higher age, male sex, peripheral vascular disease, use of insulin, hemodialysis, and higher numbers of comorbidities as significant risk factors for reamputation or in-hospital death. Use of hemodialysis was the strongest risk factor (odds ratio, 2.10; 95% confidence interval, 1.87-2.35). Conclusions: The in-hospital mortality and reamputation rates following lower limb amputation were considerably high, reflecting the severely ill conditions of patients with advanced chronic diseases. Risk factors for in-hospital death and reamputation following lower limb amputation were identified. These should aid surgeons in determining a patient's risk of a poor outcome and deciding on the level of amputation.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for In-hospital Mortality and Reamputation Following Lower Limb Amputation

Endoh

Yamana

Nakahara

et al. 2017

PRM

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“…Firstly, pre-operative septic shock, ASA 4 status and site of amputation of AKA are significant predictors of higher post-operative in hospital mortality rate and ICU admission. Previous studies evaluating non-traumatic MLEA found thatage, 6 albumin level, 6 AKA, 4,6 lack of a previous coronary artery bypass graft, 6 renal insufficiency, 4 ASA grade ≥4 12 and out-of-hours surgery 12 are factors that affect peri-operative mortality rate. This knowledge is important when risk stratifying patients before surgery.…”

Section: Discussionmentioning

confidence: 99%

“…14 There is mixed evidence in the literature when evaluating whether anaesthesia technique affects mortality rate in MLEA surgeries. One study found that the type of anaesthetic (neuraxialvs general) was not associated with survival when corrected for other variables, 12 while other studies show that avoiding general anaesthesia in favour of regional anaesthesia may improve post-operative outcomes in non-traumatic MLEA surgeries. 7,16 However, all these studies did not distinguish between central neuraxial block and peripheral nerve block in the group analysed under regional anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore

Teng¹,

Yi²,

Yong³

et al. 2017

Anesthesiol Open J

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Background: Non-traumatic Major Lower Extremity Amputation (MLEA) surgeries are associated with high post-operative morbidity and mortality rates. There are few studies evaluating factors associated with post-operative mortality rates for MLEA among Asian patients. Objective: To identify factors that affect post-operative mortality rate and ICU admission rates in patients undergoing non-traumatic MLEA surgeries in a tertiary institution in Singapore. Method: A retrospective study was performed by using the operating theatre electronic database to identify patients who underwent non-traumatic MLEA surgeries in Singapore General Hospital during the period of January 1, 2010 to December 31, 2011. Results: Data was collected from 186 non-traumatic MLEA surgeries performed during the study period. Overall post-operative in hospital mortality rate was 8.6%, higher for above knee amputation (AKA), than Through Knee Amputation (TKA) than Below Knee Amputation (BKA) (18.4% vs. 8% vs. 4.5%, p=0.015). In multivariate logistic regression analysis, site of amputation of AKA compared to BKA (odds ratio 3.9, 95% confidence interval 1.1-14.5, p=0.04), ASA 4 status (odds ratio 4.3, 95% confidence interval 1.2-14.6, p=0.02) and presence of septic shock (odds ratio 4.9, 95% confidence interval 1.4-17.3, p=0.01) were significant predictors of post-operative in hospital mortality rate. The same 3 factors were significant predictors of post-operative ICU admission rate. Use of peripheral nerve block as the sole anaesthetic technique did not affect in-hospital mortality rate (adjusted odds ratio 1.3, 95% confidence interval 0.3-5.6). Conclusion: Patients with ASA 4 status and pre-operative septic shock, especially those undergoing AKA, should be considered as high risk group and therefore managed appropriately. The higher incidence of post-operative ICU admission rate in this group of patients also necessitates pre-operative organization of bed availability. Using peripheral nerve block as the sole anaesthetic technique did not significantly affect outcomes measured.

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All‐cause and cause‐specific mortality rates after severe extremity injuries among previously deployed active duty service members

Schmied

Boltz

Levine

et al. 2023

PM&R

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BackgroundPrevious research has shown that active duty military personnel who sustain extremity injuries while in service are at elevated risk for serious physical and psychological health issues that could affect their long‐term functioning and quality of life yet longer‐term mortality has not been studied in this population.ObjectiveTo determine whether rates of all‐cause and cause‐specific mortality are elevated for active duty U.S. service members who sustained traumatic limb injuries in service, compared to the broader population of deploying service members. To assess differences in mortality rates between service members with traumatic limb injuries that did versus did not result in amputation.DesignRetrospective cohort study; archival Department of Defense deployment, personnel, medical, and death records were combined and analyzed. Standardized mortality ratios (SMR) adjusted for age, sex, and ethnoracial group, along with associated 95% confidence intervals (CIs), were calculated to directly compare all‐cause and cause‐specific mortality rates in each of the two injury groups to rates in the total study population.SettingNot applicable.ParticipantsService members who deployed in support of the global war on terror between 2001 and 2016 were eligible for inclusion; the final sample included 1,875,206 individuals surveilled through 2019.InterventionNot applicable.Main Outcome MeasuresAll‐cause and cause‐specific mortality rates.ResultsOverall, the number of deaths was over three times higher than expected among service members with amputations (SMR = 3.01; CI: 2.36–3.65), and nearly two times higher among those with serious limb injuries not resulting in amputation (SMR = 1.72; CI: 1.54–1.90) when compared to the larger study population. Rates for both internal and external causes of death were significantly elevated among those with limb injuries.ConclusionsLong‐term mortality rates are elevated among service members with traumatic limb injuries, though mortality patterns may differ based on whether the injury results in amputation. Although further research into causal mechanisms is needed, these results may inform the development of interventions to improve long‐term health outcomes among injured military personnel.

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Factors influencing short‐ and long‐term mortality after lower limb amputation

Cited by 46 publications

References 18 publications

Risk Factors for In-hospital Mortality and Reamputation Following Lower Limb Amputation

Risk Factors for In-hospital Mortality and Reamputation Following Lower Limb Amputation

Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore

All‐cause and cause‐specific mortality rates after severe extremity injuries among previously deployed active duty service members

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