Risk factors for unplanned readmission and stump complications after major lower extremity amputation

Phair, John P.; DeCarlo, Charles; Scher, Larry A.; Koleilat, Issam; Shariff, Saadat; Lipsitz, Evan C.; Garg, Karan

doi:10.1016/j.jvs.2017.08.061

Cited by 42 publications

(28 citation statements)

References 17 publications

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“…There is a lack of evidence to assist surgeons and their patients in determining the magnitude of the probable risk of healing failure and need for additional surgery at each amputation level 7,9,11 . Clinical judgement continues to be a key factor in estimating reamputation risk 8,12 .…”

Section: Introductionmentioning

confidence: 99%

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Czerniecki

Thompson

Littman

et al. 2019

British Journal of Surgery

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Background Patients undergoing amputation of the lower extremity for the complications of peripheral artery disease and/or diabetes are at risk of treatment failure and the need for reamputation at a higher level. The aim of this study was to develop a patient‐specific reamputation risk prediction model. Methods Patients with incident unilateral transmetatarsal, transtibial or transfemoral amputation between 2004 and 2014 secondary to diabetes and/or peripheral artery disease, and who survived 12 months after amputation, were identified using Veterans Health Administration databases. Procedure codes and natural language processing were used to define subsequent ipsilateral reamputation at the same or higher level. Stepdown logistic regression was used to develop the prediction model. It was then evaluated for calibration and discrimination by evaluating the goodness of fit, area under the receiver operating characteristic curve (AUC) and discrimination slope. Results Some 5260 patients were identified, of whom 1283 (24·4 per cent) underwent ipsilateral reamputation in the 12 months after initial amputation. Crude reamputation risks were 40·3, 25·9 and 9·7 per cent in the transmetatarsal, transtibial and transfemoral groups respectively. The final prediction model included 11 predictors (amputation level, sex, smoking, alcohol, rest pain, use of outpatient anticoagulants, diabetes, chronic obstructive pulmonary disease, white blood cell count, kidney failure and previous revascularization), along with four interaction terms. Evaluation of the prediction characteristics indicated good model calibration with goodness‐of‐fit testing, good discrimination (AUC 0·72) and a discrimination slope of 11·2 per cent. Conclusion A prediction model was developed to calculate individual risk of primary healing failure and the need for reamputation surgery at each amputation level. This model may assist clinical decision‐making regarding amputation‐level selection.

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Section: Introductionmentioning

confidence: 99%

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Czerniecki

Thompson

Littman

et al. 2019

British Journal of Surgery

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“…We have demonstrated a 16% reoperation rate after AKA in a cohort of patients presenting to a vascular surgery practice. This is higher than the rate reported among all comers in a recent large database study but similar to other retrospective series among patients with peripheral arterial disease . We found that patients with a history of prior revascularization were at a higher risk for reoperation; however, procedures performed to improve ipsilateral inflow to common and profunda femoris arteries were not protective against reoperation.…”

Section: Discussionmentioning

confidence: 90%

“…This is higher than the rate reported among all comers in a recent large database study 2 but similar to other retrospective series among patients with peripheral arterial disease. 2,3 We found that patients with a history of prior revascularization were at a higher risk for reoperation; however, procedures performed to improve ipsilateral inflow to common and profunda femoris arteries were not protective against reoperation. Patients with wound complications, particularly hematoma, were highest risk for reoperation; however, the use of preoperative anticoagulation did not correlate with reoperation, contrary to previous reports.…”

mentioning

confidence: 86%

Factors Associated With Unplanned Reoperation After Above-Knee Amputation

et al. 2019

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“…8,9 Among those requiring readmission, 28.6-44.8% were due to stump complications, 9,10 and 34.1% of the patients with BTK stump complications were eventually converted to above knee amputations. 9 Phair et al reported that an occluded bypass graft was a significant predictor of reoperation for stump complications. 9 Impaired arterial perfusion may pose a higher risk of unhealed stump wound and the higher level amputation consequently.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous deep venous arterialization at femoropopliteal segment for unhealed amputated stump ulcer after below the knee amputation

Ichihashi

Tamura²,

Maeda³

et al. 2021

Cathet Cardio Intervent

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Efficacy of percutaneous deep venous arterialization (pDVA) has been reported for patients with no‐option chronic limb threatening ischemia. To date, the procedure has been limited for below the knee/below the ankle occlusive disease. The present report describes the pDVA performed at a femoropopliteal segment for a patient with a stump complication after below the knee amputation. The patient was a 70‐year‐old male who had a history of endovascular treatment in the right superficial femoral artery (SFA) and below knee amputation 6 years before. He had an unhealed ulcer at the amputated stump for 3 years. Computed tomography angiography demonstrated occluded right SFA, with a stenotic popliteal artery. Revascularization was considered unfeasible due to the absence of run off vessels. In order to improve the perfusion at the ulcer, pDVA was performed at the distal SFA level, bridging SFA and femoral vein using stent grafts. The final angiogram demonstrated the revascularized SFA connecting to popliteal vein with a brisk flow. After pDVA, the stump ulcer improved and the stent grafts were kept patent after 6 months of the procedure. pDVA at the SFA level was technically feasible and could be a useful approach for stump complication after below knee amputation.

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Risk factors for unplanned readmission and stump complications after major lower extremity amputation

Cited by 42 publications

References 17 publications

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Factors Associated With Unplanned Reoperation After Above-Knee Amputation

Percutaneous deep venous arterialization at femoropopliteal segment for unhealed amputated stump ulcer after below the knee amputation

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