Perioperative mortality following above-knee amputations indicated for bone and soft tissue tumours

Whilst there are numerous studies investigating perioperative mortality of amputations performed for peripheral vascular disease, there are few studies exploring this in oncology patients. The authors have reviewed their experience in oncology patients who had had an above-knee amputation (AKA), investigating the incidence of reported thromboembolic events, and death.

Retrospective review of data stored on a prospective database.

484 patients were identified that had had an above-knee amputation between 1980 and 2011. The most common diagnosis leading to amputation was osteosarcoma (45%) followed by chondrosarcoma (6%). The majority of patients (301) underwent their above-knee amputation as a primary procedure (62%). There were two inpatient deaths soon after the above-knee amputation (mortality 0.4%) and a further two deaths within 30 days of the procedure (30 day mortality 1%). Only two deaths were directly related to the procedure and were due to a pulmonary embolism. The incidence of non-fatal, clinically evident thromboembolic events was 0.6% in the defined perioperative period of 30 days. The one-year survival was 79% and the five-year survival was 52%. Patients who had an amputation due to failure of reconstruction were found to have a better survival.

Above-knee amputations are performed mainly for vascular indications but also for bone or soft tissue tumours of the lower limbs; representing two completely different patient groups reflected by the perioperative risk, significantly lower in oncology patients (<1% vs 8-23%). Although a high risk group there is no consensus regarding thromboprophylaxis due to the increased risk of bleeding. However, due to the low complication rates of modern methods of prophylaxis the authors propose routine prophylaxis for patients undergoing above-knee amputations if they are aged over 60 or have other risk factors for thrombo-embolic disease.