Preoperative frailty is predictive of complications after major lower extremity amputation

Preoperative clinical frailty is increasingly used as a surrogate for predicting postoperative outcomes. Patients undergoing major lower extremity amputation (LEA) carry a high risk of perioperative morbidity and mortality, including high 30-day mortality and readmission rates. We hypothesized that preoperative frailty would be associated with an increased risk of postoperative mortality and readmission.

A retrospective review was performed for all patients who underwent transfemoral or transtibial amputation for any indication within a multi-institution system during a 5-year period. Standard demographics and all components of the Modified Frailty Index (mFI) were used to determine preoperative frailty status for each patient. The primary outcome was 30-day mortality, with secondary outcomes of 30-day readmission, unplanned revision, and composite adverse events.

Among 379 patients who underwent LEA, the overall readmission and mortality rates for the group were 22.69% and 6.06%, respectively. Readmission rates increased with increasing mFI score: rates were 8.6%, 13.5%, 16.3%, 19.7%, 31.4%, and 37.0% for mFI scores of 0, 1, 2, 3, 4, and ≥5, respectively (P = .015). On multivariate logistic regression, only mFI (odds ratio, 1.49, 95% confidence interval, 1.24-1.77) and sex (odds ratio, 1.81, 95% confidence interval, 1.00-2.98) were significant predictors of 30-day readmission.

Preoperative clinical frailty is associated with an increased 30-day readmission rate in patients undergoing LEA and should be incorporated into preoperative counseling and risk stratification, as well as postoperative planning and care.