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Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
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Mortality and reoperations following lower limb amputations.

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    |March 21, 2014
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    Above-the-knee amputation (AKA) and below-the-knee amputation (BKA) have high mortality rates, influenced by comorbidities and functional status. Resistant infections increase reoperation risk, not amputation level.

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    Area of Science:

    • Vascular Surgery
    • Orthopedic Surgery
    • Rehabilitation Medicine

    Background:

    • Above-the-knee amputations (AKA) and below-the-knee amputations (BKA) are common for limb salvage due to ischemia, tissue loss, or infection.
    • Previous reports suggested AKA had better wound healing but poorer rehabilitation outcomes than BKA.

    Purpose of the Study:

    • To compare outcomes of AKA versus BKA.
    • To identify risk factors associated with poor outcomes after leg amputation.

    Main Methods:

    • Retrospective cohort study of 198 amputations (91 AKA, 107 BKA) in 188 patients (mean age 72) between 2007-2010.
    • Patients underwent amputation for ischemic, infected, or gangrenotic foot; trauma and tumor cases were excluded.
    • Outcomes evaluated included mortality and reoperations (debridement, higher-level amputation conversion). Patient and surgery-related risk factors were analyzed.

    Main Results:

    • Risk factors for mortality included dementia (HR 2.769), preoperative non-ambulatory status (HR 2.281), heart failure (HR 2.013), and renal failure (HR 1.87).
    • Resistant bacterial infection was a significant risk factor for reoperation (HR 3.083).
    • Neither AKA nor BKA independently predicted mortality or reoperation.

    Conclusions:

    • Both AKA and BKA are associated with high mortality rates, primarily linked to comorbidities (renal/heart disease) and reduced functional status/dementia.
    • Resistant bacterial infections correlate with increased reoperation rates.
    • Identified risk factors can help anticipate and prevent severe complications in amputation patients.