Nutritional Status Does Not Correlate with Stump Complications in Two-stage Lower Extremity Amputations

Area of Science:

• Vascular Surgery
• Surgical Outcomes
• Nutritional Science

Background:

• Unsalvageable foot infections necessitate a two-stage amputation, starting with a guillotine below-knee amputation (BKA) followed by formalization.
• Optimal timing for formalization and the influence of nutritional status on outcomes after BKA are not well-established in existing literature.

Purpose of the Study:

• To investigate whether the timing of stump formalization after guillotine below-knee amputation (BKA) correlates with stump complications.
• To evaluate the role of specific nutritional markers (albumin, prealbumin, glycated hemoglobin) in predicting postoperative stump complications.

Main Methods:

• Retrospective review of 128 patients who underwent guillotine BKAs and subsequent formalization between 2008 and 2013.
• Data collected included comorbidities, nutritional markers (albumin, prealbumin, HbA1c), days to formalization, and postoperative complications.
• Primary outcome assessed was surgical site infection or reoperation of the stump within 30 days.

Main Results:

• A total of 17.2% of patients developed surgical site infections, and 4.9% required reoperation.
• Formalization within 14 days did not significantly increase the risk of stump complications compared to later formalization (OR 0.7; P=0.5).
• No significant differences in preoperative albumin, prealbumin, or glycated hemoglobin levels were observed between patients with and without stump complications.

Conclusions:

• Neither the timing of stump formalization nor preoperative nutritional status appears to be a significant predictor of stump complications after guillotine below-knee amputation.
• Further research may be needed to identify other factors influencing outcomes in this patient population.