Impact of Timing on Lower Extremity Amputations in Blunt Polytrauma : A Retrospective Analysis of Clinical Outcomes and Risk Factors

Abstract

Delayed amputation after failed limb salvage can lead to negative clinical and functional outcomes due to complications, including re-amputation. This study aimed to compare clinical outcomes and identify risk factors according to the timing of amputation. A retrospective review of managed lower-extremity injuries was conducted between January 2016 and December 2022 at a level 1 trauma center. Outcomes were compared between the early amputation and the delayed amputation groups (within and beyond 48 h after the time of injury, respectively). The primary outcome of interest was that the risk factors changed to a more proximal amputation level according to the timing of amputation. The secondary outcomes included trauma-related complications and clinical outcomes. The incidence of trauma-related complications was more common in the delayed amputation group with no significant differences in 30-day mortality. Delayed amputation and stump site deep surgical infection were associated with higher odds of changing to a more proximal level than initially predicted. The overall hospital stay was significantly longer in the delayed amputation group. Although patients and clinicians prefer the limb salvage strategy, delayed amputation could be a risk factor for shorter limb stumps due to re-amputation, and patients may experience more trauma-related complications and prolonged hospitalization.