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Difficult to predict early failure after major lower-extremity amputations.

Morten Tange Kristensen1, Gitte Holm, Peter Gebuhr

  • 1mortentange@hotmail.com.

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Major lower-extremity amputation outcomes were poor, with high short-term failure rates. No clear predictors for amputation failure were identified, highlighting a need for better pre-operative planning.

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Area of Science:

  • Orthopaedic Surgery
  • Vascular Surgery
  • Patient Outcomes

Background:

  • Successful major amputation outcomes depend on stump wound healing.
  • Identifying factors for early amputation failure is crucial for improving patient care.
  • Non-traumatic lower-extremity amputations present significant challenges.

Purpose of the Study:

  • To examine the criteria for index amputations.
  • To identify factors associated with early amputation failure (within 30 days).
  • To evaluate outcomes of major non-traumatic lower-extremity amputations.

Main Methods:

  • A consecutive one-year series of 70 patients (36 men, 34 women) aged 72 years (median) undergoing major lower-extremity amputation.
  • Evaluation of patient characteristics and other potential factors influencing early amputation failure.
  • Data collected included amputation level (44 below-knee, 26 above-knee) and American Society of Anesthesiologists (ASA) rating (47 > 2).

Main Results:

  • High rates of short-term failure: 16% mortality, 16% re-amputation, and 6% major revision within 30 days.
  • No preoperative factors, including skin perfusion tests, predicted early amputation failure.
  • Patients experiencing failure had significantly longer hospital stays (median 45 days vs. 20 days).

Conclusions:

  • The rate of short-term amputation failures in this cohort was high.
  • No clear predictors for early amputation failure were identified.
  • A pre-amputation algorithm is needed to support optimal level selection for lower-extremity amputations.