The impact of previous surgery and revisions on outcome after major lower limb amputation
Rachel Barnes1, Panos Souroullas1, Risha A Lane1
1Academic Vascular Surgical Unit, Hull and East Yorkshire NHS Trust/Hull York Medical School, Hull, UK.
Insights
Previous vascular intervention before major lower limb amputation (LLA) increases the risk of revision surgery but does not affect survival rates. This finding is crucial for managing patients undergoing amputation.
Area of Science:
- Vascular Surgery
- Amputation Outcomes
- Limb Salvage
Background:
- High morbidity and mortality rates persist after lower limb amputation (LLA).
- Previous ipsilateral vascular intervention's impact on LLA outcomes requires assessment.
Purpose of the Study:
- To evaluate the effect of prior ipsilateral vascular intervention on major lower limb amputation outcomes.
- To determine if previous interventions are a risk factor for morbidity and mortality post-LLA.
Main Methods:
- Prospective data collection for major LLAs from January 2010 to December 2011.
- Comparison of primary amputees versus secondary amputees (those with prior vascular intervention).
Main Results:
- 46 out of 148 patients (31.1%) had prior ipsilateral revascularization.
- Secondary amputees were older and had higher rates of hypercholesterolemia.
- Previous intervention correlated with a higher likelihood of revision surgery (17% vs. 4.5%).
- No significant association found between prior intervention and amputation level or postoperative mortality.
Conclusions:
- Patients with prior revascularization may face an elevated risk of revision surgery after major lower limb amputation.
- Survival outcomes following major lower limb amputation are not adversely affected by previous revascularization attempts.
Introduction:
Morbidity and mortality after lower limb amputation (LLA) remain disappointingly high. This study aimed to assess the impact of previous ipsilateral vascular intervention on outcomes after major LLA.
Methods:
Prospective data were collected for all major LLAs performed between January 2010 and December 2011. Those who underwent a primary amputation were compared with secondary amputees to establish if previous interventions were a risk factor for morbidity and mortality.
Results:
One hundred forty-eight patients underwent LLA during the study period; 102 were primary amputees, and 46 (31.1%) had undergone previous ipsilateral revascularization. The groups were well matched for demographics and comorbidities. Those who underwent secondary amputations were older (P=0.016) and more likely to suffer from hypercholesterolemia (P<0.001). Patients who had undergone a previous intervention were more likely to need revision surgery (17% vs. 4.5% P=0.027). Previous intervention was not found to be a risk factor for more proximal amputation level (P=0.341) or increased postoperative mortality (P=0.782), however.
Conclusions:
Patients who have undergone previous revascularization may be at higher risk of revision surgery. Survival after major LLA does not appear to be associated with previous revascularization attempts.
