Preoperative factors predict mortality after major lower-extremity amputation.

Area of Science:

• Surgical Outcomes Research
• Medical Informatics
• Patient Risk Stratification

Background:

• Major amputation, including above-knee (AKA) and below-knee amputation (BKA), carries significant perioperative risk.
• Accurate prediction of mortality is crucial for patient management and surgical decision-making.

Purpose of the Study:

• To develop and validate a preoperative mortality risk stratification tool for patients undergoing major lower extremity amputation.
• To identify key preoperative factors associated with 30-day mortality following AKA and BKA.

Main Methods:

• Utilized data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005-2010).
• Conducted univariate and multivariate analyses to identify predictors of 30-day mortality.
• Developed and validated multivariable prediction models for mortality risk.

Main Results:

• Analyzed 9,368 patients (4,032 AKA, 5,336 BKA).
• 30-day mortality was 12.8% for AKA versus 6.5% for BKA (P < .001).
• Identified preoperative factors predicting mortality: older age, dependent functional status, dialysis, steroid use, sepsis, delirium, thrombocytopenia, elevated INR, and azotemia. Predictive models showed good accuracy (Concordance Index 0.75 for AKA, 0.81 for BKA).

Conclusions:

• Preoperative clinical factors effectively predict 30-day mortality after major amputation.
• The developed risk calculator can aid surgeons and patients in informed decision-making and setting realistic expectations.
• This tool enhances risk stratification for patients facing limb-threatening conditions requiring amputation.